Search Decisions

Decision Text

AF | PDBR | CY2012 | PD-2012-00083
Original file (PD-2012-00083.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       BRANCH OF SERVICE: MARINE CORPS
CASE NUMBER: PD-2012-00083 SEPARATION DATE: 20070508
BOARD DATE: 20120724


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CW-2 (0170/Personnel Officer), medically separated for bilateral metatarsalgia (foot pain). The CI developed bilateral foot pain following bilateral femoral stress fractures and hip pain in 2005 during Warrant Officer Basic School. He was placed on light duty, non-weight bearing and prescribed orthotic devices. Although the bilateral hip pain decreased, the CI’s bilateral foot pain (bilateral metatarsalgia) condition could not be adequately rehabilitated. The CI did not improve adequately with treatment to meet the physical requirements of his Military Occupational Specialty (MOS), satisfy physical fitness standards, or attend the Warrant Officer Basic Course. He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB). Enthesopathy of ankle and tarsus, unspecified (disorder of the muscular or tendinous attachment to bone); and equinus deformity of foot, acquired were forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated the bilateral metatarsalgia condition as unfitting, rated 10% for each foot with application of the bilateral factor for a combined 20%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). Bilateral gastroc equines was determined to be not unfitting and adjudicated as Category II (related to the unfitting condition). The CI made no appeals, and was medically separated with a 20% disability rating.


CI CONTENTION: “I am requesting a review of separation where my rating was 20 percent and I did not otherwise retire. The review will evaluate whether, under the applicable guidance in effect at the time, the rating awarded was fair and accurate. The PEB rating included a rating for Bilateral Metatarsalgia (code 5279-5003) and Bilateral Gastroc Equinus (No diagnostic Code) for a combined rating of 20%. Bilateral Gastroc (Gastrocnemius) Equinus should have been rated under VASRD code 5311 (Moderate) for a combined bilateral rating of 20% with a final PEB rating of 40%.”


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The Bilateral Gastroc Equinus condition requested for consideration, and the unfitting Bilateral Metatarsalgia conditions meet the criteria prescribed in DoDI 6040.44 for Board purview, and are accordingly addressed below. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records (BCNR).



RATING COMPARISON :

Service PEB – Dated 20070103
 VA (# Mos. Pre/Post-Separation) – All Effective Date 20070509
Condition
 Code Rating Condition Code Rating Exam
Bilateral Metatarsalgia Right 5279-5003 10% Right Foot, Metatarsalgia, with Plantar Fasciitis with Sensory Neuritis, Medial Plantar Nerve 5020-5279 10% 20070509
Left 5279-5003 10% Left Foot, Metatarsalgia, with Plantar Fasciitis with Sensory Neuritis, Medial Plantar Nerve 5020-5279 10% 20070509
Bilateral Gastroc Equinus Cat 2
↓No Additional MEB/PEB Entries↓
 L. Wrist Strain 5215-5019 10% 20070509
R. Wrist Strain 52155019 10% 20070509
L. Femoral Neck, s/p Stress Fx 5255-5019 10% 20070509
R. Femoral Neck, s/p Stress Fx 5255-5019 10% 20070509
R. Thumb & Index Finger Strain 5223-5019 10% 20070509
R. Knee PFS 5260-5024 10% 20070509
Osteoarthritis, T-Spine … Strain 5237-5242 10% 20070509
Tinnitus 6260 10% 20070509
Not Service-Connected x 2 20070509
Combined: 20%
 Combined: 70%


ANALYSIS SUMMARY: The Board acknowledges the CI's contention suggesting that ratings should have been conferred for other conditions documented at the time of separation, some of which were evaluated and determined not to be individually unfitting for continued service. The Board wishes to clarify that it is subject to the same laws for disability entitlements as those under which the Disability Evaluation System (DES) operates. The DES is responsible for maintaining a fit and vital fighting force. While the DES considers all of the service member's medical conditions, compensation can only be offered for those medical conditions that cut short a service member’s career, and then only to the degree of severity present at the time of final disposition. However the Department of Veterans’ Affairs (DVA), operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board is empowered to evaluate the fairness of fitness determinations, and to make recommendations for rating of conditions which it concludes would have independently prevented the performance of required duties (at the time of separation). The Board’s threshold for countering DES fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

Bilateral Metatarsalgia Condition. At the MEB exam, the CI reported continued bilateral foot pain with activity or standing over 15 minutes. Additional symptoms were bilateral forefoot tingling and numbness accompanying the pain. The CI was taking non-steroidal anti-inflammatory medication (Motrin) as needed. The MEB physical exam noted a mild collapse of the foot with stance and mild pronation with gait. Motor, sensory, reflex, and skin exams were normal. At the narrative summary (NARSUM) exam, there was no tenderness; however, the MEB exam (DD Form 2808) indicated tenderness to palpation in the forefoot (at the MTP joints). Both the NARSUM and MEB exam indicated decreased ankle dorsiflexion with a straight knee (<10⁰; normal 20⁰) that was over 10⁰ with the knee bent. Radiographs were normal.

At the VA Compensation and Pension (C&P) exam prior to separation, the CI reported the same history and complaints as noted by the NARSUM. The exam documented normal gait and posture, tenderness on palpation of the plantar forefoot and metatarsal heads of both feet. Numbness and tingling was noted in part of the distribution of the plantar nerve. There was no radiographic abnormalities and no indication of flat feet, mal alignment of the foot or Achilles tendon, or plantar fascia abnormality in either foot.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA coded each foot at 10%, using different analogous coding. The PEB coded analogously with 5279 (metatarsalgia, anterior) and 5003 (arthritis, degenerative). Of note the 5279 coding criteria is 10% for metatarsalgia, anterior (Morton’s disease), unilateral, or bilateral, and the analogous coding provided a 10% rating for each foot. The VA analogous coding of 5020 (synovitis) and 5279 (metatarsalgia), provided the same 10% rating for each foot, and neither coding option was considered predominate.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the Bilateral Metatarsalgia condition.

Contended PEB Conditions. The contended condition adjudicated as not unfitting (Category II) by the PEB was bilateral gastroc equinus: “bilateral gastroc (gastrocnemius) equinus should have been rated under VASRD code 5311 (moderate) [muscle group XI] for a combined bilateral rating of 20%.” The Board’s first charge with respect to this condition is an assessment of the appropriateness of the PEB’s fitness adjudication. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. This condition was noted in the NARSUM and MEB and was clinically tied to the CI’s bilateral unfitting foot condition(s). This condition was reviewed by the action officer and considered by the Board. The Board considered the tenants of VASRD §4.55 (principles of combined ratings for muscle injuries) and §4.56 (evaluation of muscle disabilities). The record did not indicate significant cardinal signs and symptoms of muscle disability such as loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination or uncertainty of movement, and there was no indication of any muscle injury. If unfitting, the VASRD muscle rating would be at the 0% (slight) level. Any disability from the bilateral gastroc equinus was appropriately considered under the CI’s unfitting bilateral metatarsalgia ratings. The VASRD no longer allows for three disability codes, so although analogous coding would be 5311-5279-5003 (or 5003) is not possible and would not increase the CI’s final disability rating. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended bilateral gastroc equinus condition; and, therefore, no additional disability ratings can be recommended.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the bilateral metatarsalgia condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended bilateral gastroc equinus conditions, the Board unanimously recommends no change from the PEB determination as not unfitting. There were no other conditions within the Board’s scope of review for consideration.



RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION VASRD CODE RATING
Bilateral Metatarsalgia Right 5279-5003 10%
Left 5279-5003 10%
COMBINED (w/ BLF) 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120224, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         XXXXXXXXXXXXXXXXXXXX
         President
         Physical Disability Board of Review
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 16 Aug 12

 In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR that the following individuals’ records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy Physical Evaluation Board:

-       
former USMC
-        former USN
-        former USN
-        former USN
-        former USMC
-        former USN



         XXXXXXXXXXXXXXXXXXXX
         Assistant General Counsel
         (Manpower & Reserve Affairs)

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-02563

    Original file (PD-2013-02563.rtf) Auto-classification: Denied

    Right Foot/Lower ExtremityCondition (Heel Spur, Plantar Fasciitis, Hammer Toe,Achilles and Gastroc-Soleus Tendinitis) .The service treatment record (STR) contains a routine exam entry from 1997 (same year as enlistment) documenting hallux valgus (bunion deformity of the big toe); and, a clinic note from the same year noting a 4-month history of bilateral foot pain. The PEB rated the right foot condition analogously under 5279 (metatarsalgia) which provides for a maximum rating of 10%, under...

  • AF | PDBR | CY2011 | PD2011-00755

    Original file (PD2011-00755.docx) Auto-classification: Denied

    PHYSICAL DISABILITY BOARD OF REVIEW Right Foot Condition. Physical Disability Board of Review

  • AF | PDBR | CY2010 | PD2010-00045

    Original file (PD2010-00045.docx) Auto-classification: Denied

    The Board considered rating the left ankle degeneration separately, but determined the rear-foot pain was best considered as degenerative changes of the left rear foot which also contributed to the limitation of ankle motion from the plantar fasciitis. The Board recommends no additional separately unfitting foot or ankle condition, or change in the PEB adjudications other than PF, and all symptoms were considered under the separate 5399-5310 coding ratings above. Exhibit C. Department of...

  • AF | PDBR | CY2011 | PD2011-01101

    Original file (PD2011-01101.pdf) Auto-classification: Approved

    An additional combined condition, “secondary low back and bilateral knee pain” was forwarded as “not boardable.” The PEB (via an Informal Reconsideration following an appeal) conceded aggravation of the congenital podiatric conditions; and, consolidated three of the MEB submitted conditions (as specified in the PEB’s DA Form 199 language quoted below) as a single unfitting condition characterized as “Painful feet on [sic] ankles due to plantar fasciitis and posterior tibial tendonitis with...

  • AF | PDBR | CY2012 | PD 2012 01091

    Original file (PD 2012 01091.txt) Auto-classification: Approved

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201091 SEPARATION DATE: 20020307 BOARD DATE: 20121205 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (71L/Administrative Specialist), medically separated for chronic bilateral foot pain secondary to plantar fasciitis with underlying congenital condition of pes planus. The...

  • AF | PDBR | CY2013 | PD-2013-01403

    Original file (PD-2013-01403.rtf) Auto-classification: Denied

    The bilateral foot condition, characterized as “plantar fasciitis (PF)” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Board therefore, only reviewed to see if a higher combined rating was achieved with any applicable VASRD code. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

  • AF | PDBR | CY2011 | PD2011-01102

    Original file (PD2011-01102.docx) Auto-classification: Approved

    The PEB adjudicated the bilateral, plantar fasciitis and bilateral flat feet conditions as unfitting, rated 0%, with application of the U.S. Army Physical Disability Agency (USAPDA) pain policy. It noted the progression of the bilateral foot pain despite conservative treatment and limitation of activities; “currently, her feet still hurt and she is not doing any high impact activities but the pain is starting to increase.” The examination documented bilateral pes planus and tenderness on...

  • AF | PDBR | CY2011 | PD2011-01009

    Original file (PD2011-01009.docx) Auto-classification: Approved

    The Informal Reconsideration PEB adjudicated the pes valgoplanus and secondary plantar fasciitis condition and the right wrist pain condition as unfitting, rated 20% and 0% respectively, with application of the Veterans Administration Schedule for Rating Disabilities (VASRD) and specified application of the US Army Physical Disability Agency (USAPDA) pain policy respectively. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; and, that the...

  • AF | PDBR | CY2013 | PD2013 00694

    Original file (PD2013 00694.rtf) Auto-classification: Denied

    The CI had a long history of bilateral foot pain finally diagnosed as chronic bilateral fasciitis in 2001. The NARSUM and the C&P exam contain language that the CI was functional but had pain in both feet only with prolonged activity. Physical Disability Board of Review

  • AF | PDBR | CY2011 | PD2011-00599

    Original file (PD2011-00599.docx) Auto-classification: Denied

    PHYSICAL DISABILITY BOARD OF REVIEW The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation. The PEB adjudicated the foot condition as chronic foot pain secondary to stress fractures and plantar fasciitis under code 5279 metatarsalgia at 10 % disability rating, the only rating under this code.