Search Decisions

Decision Text

AF | PDBR | CY2012 | PD2012 01157
Original file (PD2012 01157.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201157
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130620
SEPARATION DATE: 20040317


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Petty Officer Third Class (PO3)/E-4 (Mess Management Specialist) medically separated for bilateral plantar fasciitis condition. The bilateral plantar fasciitis condition could not be adequately rehabilitated to meet the physical requirements of her rating or satisfy physical fitness standards. She was placed on limited duty for 8 months without resolution of her symptoms and then referred for a Medical Evaluation Board (MEB). Bilateral plantar fasciitis and bilateral pes planus were forwarded to the Informal Physical Evaluation Board (IPEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The IPEB adjudicated bilateral plantar fasciitis as unfitting, rated 10% and 0% ( not specified, but probably left and right, respectively) with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD). The bilateral pes planus condition was determined to be a C ategory II condition ( one which contributes to the unfitting condition) . The CI appealed to the Formal PEB (FPEB), which changed the PEB rating for the plantar fasciitis to 10% for each side for a combined rating of 19%, rounded to 20% after application of the bilateral factor. The CI made no further appeals and was medically separated.


CI CONTENTION: “The rating of 20% was given by the Review Board (2003-2004),while the request for a minimum of 30% was my request due to the inability for me to return to duty which was stated by the USN and Civilian podiatrist and doctors (see medical records) or to retire as I had planned to do with my career. Years of physical therapy, medication, and therapy has become part of my life as I do all that I can to live with my disabilities. The eleven plus years that I served my country makes me very proud, but the denial of retirement after doing over half of my years as I worked towards achieving retirement has left me with emotional scares. I can never get back the years and I do not regret ever serving my country but I do believe that my country should take care of the people who will give their all, including their lives for this country. I will always be reminded of my service to my country due to my continual back and foot pain, memories, and daily medication intake but I am elated that I have an opportunity to receive my retirement from the USN as I originally fought to receive.”


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting bilateral plantar fasciitis and the bilateral pes planus conditions are within the DoDI 6040.44 defined purview of the Board condition and are 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.


RATING COMPARISON :

Service FPEB – Dated 20030514
 VA - (Four days Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Plantar Fasciitis 5399-5310 10%+10% Bilateral Pes Planus/Plantar Fasciitis 5277-5276 10%* 20030515
Bilateral Pes Planus CAT II
No Additional MEB/PEB Entries
 Other x 4/0% x 1/ NSC x 3 20030515
Combined: 20%
 Combined: 40%**
Derived from VA Rating Decision (VA RD ) dated 200 3 40421 ( most proximate to date of separation [ DOS ] ).
* Initially rated 0% and coded 5276 prior to separation.
** Combined rating was 20% from 10/02/2003; increased to 40% from 03/18/2004.

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veteran Affairs (DVA) but not determined to be unfitting by the PEB. However, the 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’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation.

Bilateral Plantar Fasciitis Condition. The CI was first documented to have left ankle pain, in February 1994, due to pain and swelling in ankles and feet, with no history of trauma, less than 2 months after accession. She treated for “ankle/foot cellulitis/stress edema” with Motrin and told to wear tennis shoes for three days. In August 1995, a car ran over the CI’s left lower extremity (LLE), as she was getting out of the car and it was pulling away from the curb. The CI was referred to the orthopedic clinic where X-ray evaluation revealed no fracture or dislocation of the LLE. The CI had healed well at a 4 week follow up appointment. The next recorded visit for the left foot was in sick call on October 19, 2000; she attributed the left foot pain to her left foot injury in 1995. She was noted to have tenderness of the left plantar fascia, but she otherwise had a normal examination. Ankle X-rays were normal. She was seen again on 25 January 2001 and noted to have pes planus and referred to orthopedics. The orthopedist noted a 3 year history of left heel pain, diagnosed left plantar fasciitis, and recommended stretching exercises, a heel cap, night splint, and a non-steroidal anti-inflammatory drug. A bone scan performed on 5 November 2001 revealed non-specific mild uptake in the left knee and foot, but no uptake in the region of the plantar fascia. An orthopedic note on 7 February 2002 noted mild pes planus in both feet and tenderness to palpation over the left plantar fascia; limited duty was recommended. The CI continued conservative treatment including steroid injection of the left plantar fascia. She made some progress, but it was not sufficient for return to full duty. The Report of the Medical Board dictated on 11 October 2002 noted that the CI was unable to do much physical activity without pain. She reported pain in both legs and feet with standing greater than one hour. She was unable to stand or participate in physical readiness training. The MEB physical examiner noted that the CI had full range-of-motion of her joints (knees and ankles) and TTP over the origin of the plantar fascia bilaterally. Pes planus was present bilaterally. The examiner reported, “she was able to do a single-stance heel raise bilaterally.” The VA Compensation and Pension (C&P) examination was performed on March 15, 2003, a year prior to separation. The same examiner had examined the CI in January 2002 at a previous C&P examination. The CI reported continued discomfort in her left lower extremity that was “now spreading to the left knee.” She continued to use orthotic devices, but did not use heel cups. The CI was pregnant and unable to obtain X-ray studies. The CI reported having no additional treatment for the plantar fasciitis since the C&P examination performed in January 2002. The CI was 63 inches tall and weighed 174 pounds, an increase of 36 pounds from accession. Her gait was normal with tennis shoes; however, she complained “bitterly” of discomfort when she attempted to walk on her heels. She was able to walk on her toes and squat with difficulty. The examiner reported flattening of the longitudinal arch and transverse metatarsal arch along with tenderness on both feet. There was also “slight tenderness” to deep palpation on the anterior border of the right calcaneus; the left was “much more tender.” The Board noted that this is the location of insertion for the plantar fascia into the calcaneus (heel bone). The CI continued to be seen for her bilateral foot pain, without significant improvement, until separation. The working diagnosis remained bilateral, left greater than right, plantar fasciitis; pes planus was also noted bilaterally.

The Board directs attention to its rating recommendation based on the above evidence. There is not a specific VASRD code for plantar fasciitis. The PEB rated the right and left plantar fasciitis conditions 10% each, coded analogously under muscle code 5310 for a total disability rating of 20%, including the bilateral factor. The VA initially adjudicated a zero percent (0%) rating coding analogously to 5276 (acquired pes planus) relying on the normal C&P examination 10 months prior to separation, but later raised this to 10% for the bilateral pes planus/plantar fasciitis condition relying on the same examination and the service treatment records. The Board considered the coding options for the plantar fasciitis condition. The 5310 code used by the PEB incorporates the plantar aponeurosis (fascia) in its description. The 5276 code is for pes planus, a condition associated with, but separate from, the unfitting plantar fasciitis condition. The coding option 5020, synovitis, is also an appropriate analogous code for plantar fasciitis as is 5284, other foot injuries. The Board noted that the CI had a normal gait while wearing shoes of comfort, even while pregnant and 36 pounds heavier than at accession, consistent with a mild impairment. The Board considered the different coding options available; none provided a route to a higher rating that the bilateral 10% rating adjudicated by the FPEB. 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 plantar fasciitis condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that bilateral pes planus condition was a condition that contributed the unfitting condition, but was not separately unfitting. 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. The bilateral pes planus condition was not profiled or specifically implicated in the commander’s statement. The condition was judged to fail retention standards; however, it was determined to be not separately unfitting by the PEB. The clinical examination was consistent with pain from the plantar fasciitis and the pes planus appeared to be an incidental finding discovered during the evaluation for the plantar fasciitis. In addition, the primary impairment manifested for the bilateral foot condition was from pain. The bilateral foot pain was attributed to the unfitting bilateral plantar fasciitis condition. Even if the pes planus had been determined to be separately unfitting, the pain could not also be used for rating the pes planus condition without violating VASRD §4.14, avoidance of pyramiding, and no additional disability could be adjudicated. The pes planus condition was reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that the pes planus condition significantly interfered with satisfactory duty performance. 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 pes planus contended conditions and so no additional disability rating are 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 plantar fasciitis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended pes planus condition, 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 Plantar Fasciitis Condition 5399-5310 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120613, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





xx
President
Physical Disability Board of Review

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01817

    Original file (PD-2013-01817.rtf) Auto-classification: Approved

    The rating for the unfitting chronic recurrent plantar fasciitis bilaterally and equinus deformity bilaterally conditions are addressed below;no additional conditions are within the DoDI 6040.44 defined purview of the Board. When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the Disability...

  • AF | PDBR | CY2011 | PD2011-00968

    Original file (PD2011-00968.docx) Auto-classification: Approved

    Gait disturbance or use of an assistive device was not documented in the narrative summary (NARSUM) or in proximate outpatient notes; and was attributed to the lumbar spine condition in the VA rating decision. Its application in this case would therefore entail separate ratings; which was the rating choice pursued by the VA. IAW VASRD §4.7 (higher of two evaluations), the Board must consider separate ratings for PEB combined adjudications; although, separate fitness assessments must justify...

  • AF | PDBR | CY2013 | PD-2013-01282

    Original file (PD-2013-01282.rtf) Auto-classification: Approved

    Pre-Separation) ConditionCodeRatingConditionCodeRatingExam Pes Planus with History of Plantar Fasciitis5299-52760%Left Plantar Fasciitis527610%20040602Right Plantar Fasciitis527610%20040602Other X 0 (Not in Scope)Other x1520040602 Combined: 0%Combined: 50%Derived from VA Rating Decision (VARD) dated 20041027(most proximate to date of separation) ANALYSIS SUMMARY :The Board acknowledges the presence of “breathing problems, sleep apnea, depression, knees” as sevice-connected conditions by the...

  • AF | PDBR | CY2014 | PD-2014-00091

    Original file (PD-2014-00091.rtf) Auto-classification: Approved

    The left foot conditions, characterized as “symptomatic pes planus on the left foot” and “left plantar fasciitis” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. Post-Separation)ConditionCodeRatingConditionCodeRatingExam Plantar Fasciitis Left Foot w/ Congenital Pes Planus5399-53100%Left Foot Plantar Fasciitis and Pes Planus52760%*20060102Other x1 (Not in Scope)Other x7 Combined: 0%Combined: 40%Derived from VA Rating Decision (VARD)dated 20060410(most proximate to date...

  • AF | PDBR | CY2009 | PD2009-00707

    Original file (PD2009-00707.docx) Auto-classification: Denied

    The VA considered the CI’s foot conditions (Bilateral Plantar Fasciitis with Pes Planus) as combining for foot disability IAW VASRD §4.71a-29 using rating Code 5276 Flatfoot; acquired and awarded the CI with a rating of 30% (severe, bilateral). The Board considered the overlap of foot symptoms from the two inter-related conditions (Plantar Fasciitis and Pes Planus) and rating as a single bilateral code of 5276 at 30% (severe, bilateral) as the VA rated the combined foot conditions. After...

  • AF | PDBR | CY2011 | PD2011-01091

    Original file (PD2011-01091.docx) Auto-classification: Denied

    The PEB adjudicated the bilateral plantar fasciitis with underlying pes planus condition, and recurrent skin abscesses condition as unfitting, rated 0% and 0% respectively, with application of the Veterans Administration Schedule for Rating Disabilities (VASRD). The left knee osteochondral defect and left ankle sprain conditions requested for consideration and the unfitting plantar fasciitis and recurrent skin abscesses conditions meet the criteria prescribed in DoDI 6040.44 for Board...

  • AF | PDBR | CY2012 | PD2012-00031

    Original file (PD2012-00031.docx) Auto-classification: Denied

    Bilateral Foot/Ankle Condition . The MEB physical exam demonstrated; a slow gait, bilateral tenderness of the ankles, increased pain along the posterior region of the left ankle, negative medial and lateral pain of the right ankle, bilateral tenderness over the plantar fascia and also on the area of the medial heads of the calcaneus (heel bone), bilateral pes planus (flat foot), a scar on the left big toe, without erythema, edema or instability of the ankles. RECOMMENDATION : The Board,...

  • AF | PDBR | CY2011 | PD2011-00636

    Original file (PD2011-00636.docx) Auto-classification: Approved

    Bilateral Foot Condition . Secondly, the congenital pes planus condition itself was not service-aggravated; rather, the painful complications of plantar fasciitis and/or tendinitis were the service-acquired and unfitting conditions (e.g., subject to disability rating). In the matter of the bilateral plantar fasciitis condition, the Board unanimously recommends that each foot be separately adjudicated as follows: an unfitting right plantar fasciitis condition coded 5399-5310 and rated 10%;...

  • AF | PDBR | CY2012 | PD-2012-00346

    Original file (PD-2012-00346.pdf) Auto-classification: Denied

    The MEB determined the “mechanical thoracic spine pain secondary to mild thoracic scoliosis and arthritis/degenerative changes of the thoracic spine” and “plantar fasciitis, left foot” to be medically unacceptable and referred these conditions to the Physical Evaluation Board (PEB). The examiner noted that the spine was normal. RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation: VASRD CODE...

  • 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...