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AF | PDBR | CY2013 | PD-2013-01901
Original file (PD-2013-01901.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-01901
BRANCH OF SERVICE: NAVY  BOARD DATE: 20150129
SEPARATION DATE: 20041001


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Versatile Exercise Mine System Technician) medically separated for bilateral plantar fasciitis. The condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The “plantar fascial fibromatosis” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. Although no other conditions were submitted by the MEB, the PEB also considered sleep apnea which was referenced in the MEB’s narrative summary (NARSUM). The Informal PEB adjudicated his plantar fasciitis as unfitting and rated it at 10%. The sleep apnea was determined to be C ategory III . The CI made no appeals and was medically separated although he had served over 19 years of active duty. He was counseled to seek permanent limited duty status, but did not pursue that avenue to military retirement.


CI CONTENTION: “I served Honorably for 19 Years 2 months, and was found unfit to continue services base on one (1) medical fact (Chronic, Recurring, Bilateral Plantar Fasciitis) in which at the time of exams my medical records supported various issues at hand, and two (2) issues were never formally addressed due to the severity. I believe it would have impacted my military service, and some responsibility of the service: (to be name) Type 1 Diabetes & Persian Gulf War Syndrome). Sleep Apnea was ruled during the med board not to be an issue for unfit condition-but was rated by the VA in a letter dated April 20, 2005, 50% as service-connected disability effective as of October 02, 2004, but rated only 10% disabled for Bilateral plantar fasciitis by the Navy & VA. The Navy had never consider Hypertrophy of the prostate in which the VA. Rated as 20%, Scaring VA rated 10%, Allergic Conjunctivitis VA rated 10%, Migraine Headaches VA Rated 0%, Right & Left Wrist VA rated 0% and a few more which can be reviewed on dated letter. VA letter dated April 24, 2012 effective October 31, 2011 updating conditions: Migraine Headaches VA Rated 50%, Right & Left Wrist VA rated 10% each, Sinusitis/Allergic VA Rated 30%. Various medical record entries and lab reports suggest Type 1 Diabetes while serving on active duty, possible first sign of diabetes from lab report dated August 14, 2001 ordered by Dr. F--, NAVHOSP Charleston form dated September 19, 2002 and other factors being overweight for various years as noted in medical records. At first check in with VA Grand Rapids, Michigan in 2005 was asked if l had been told I was a diabetic, in which they started treatment for Type 1, using just meds to control. I am currently using meds and insulin to control. Other issue suggested by areas rated by VA and Medical records based on dates of services (Persian Gulf War Syndrome) ratable symptom: muscle & joint pain, irritability, chronic fatigue, Sleep Difficulties, Headaches, diarrhea & intestinal problems. Base on these factors I believe my rating should be change and update accordingly.”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.
Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

IPEB – Dated 20040803
 VA* - (~1 Month Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic…Bilateral Plantar Fasciitis 5399-5310 10% Bilateral Plantar Fasciitis 5276 10% 20041108
Sleep Apnea Category III Sleep Apnea 6847 50% 20041108
Other x 0 (Not In Scope)
 Other x 18
RATING: 10%
 RATING: 70%
* Derived from VA Rating Decision (VA RD ) dated 200 50412 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY:

Plantar Fasciitis. Service treatment records evidence that the CI presented with bilateral foot pain in early 2003. He was diagnosed with bilateral pes planus and planter fascitis. He was treated with activity modification, anti-inflammatory medications, custom orthotics, and steroid injection without relief. Radiographic evaluation dated 17 September 2003 demonstrated small calcaneal (heel) spurs. The CI underwent a course of physical therapy with intermittent relief. An orthopedic evaluation dated 25 June 2004 noted a diagnosis of recalcitrant arch pain bilaterally with a recommendation surgical intervention. The NARSUM examination dated 9 June 2004 noted no sustained bilateral plantar fascitis pain relief without numbness, tingling, or radiculopathy. The examination demonstrated bilateral tenderness to palpation of the “entire plantar surfaces.” A diagnosis of “chronic, recurring, bilateral plantar fascitis recalcitrant to conservative treatment” was rendered. At the VA Compensation and Pension examination, a month after separation the CI reported pain in the soles of his feet for the first 30 minutes of every day after getting out of bed in the morning. He reported pain with prolonged standing and heavy lifting. He took Ibuprofen for relief. The examination demonstrated bilateral tenderness on direct palpation of the plantar surface of the midfoot and mild lateral tracking of the Achilles tendon. The examiner noted that there was neither callus formation nor evidence of abnormal wear. A diagnosis of plantar fasciitis was continued.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB adjudicated the “chronic, recurring, bilateral plantar fascitis” condition as unfitting with a disability rating of 10% , coded analogous to injury of muscle Group X; 5399-5310. The VA rated the bilateral plantar fascitis condition at 10%, coded 5276 (pes planus). The Board noted that the PEB rated the bilateral plantar fascitis as a single unfitting condition. Although VASRD §4.71a permits combined ratings for the feet, it allows separate ratings for separately compensable foot pathology under codes 5284 and 5310. If supported under VASRD §4.71a, separate ratings for the PEB bilateral foot adjudication may be recommended by the Board if members determine that each joint is reasonably justified as separately unfitting. In this case a bilateral condition was profiled, determined to fail retention standards, and implicated in the commander’s statement. Members agreed that each foot is separately unfitting and that identical coding and ratings are applicable.
The Board considered whether there was evidence in support of a higher than 10% for either combined or separate rating of the bilateral plantar fascitis condition. VASRD code 5279 (metatarsalgia [pain the foot]) is limited to a 10% rating for unilateral and bilateral involvement. There was no evidence of marked foot deformity, swelling on use or callosities for an analogous 30% bilateral pes planus rating under VASRD 5276. The Board determined that the functional limitations of the bilateral plantar fascitis condition did not rise to the level of moderately severe for a 20% disability rating under VASRD codes 5284 and 5310. 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 sleep apnea condition was not unfitting. The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The sleep apnea condition was not profiled and was not judged to fail retention standards. All were reviewed and considered by the Board. There was no performance based evidence from the record that the sleep apnea 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 sleep apnea condition and so no additional disability rating is 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 fascitis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended sleep apnea condition, the Board unanimously recommends no change from the PEB determinations 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131014, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





                                   
XXXXXXXXXXXXXXX
President
DoD 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 29 May 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s 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’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC



                           XXXXXXXXXXXXXXX
                          Assistant General Counsel
                           (Manpower & Reserve Affairs)

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