Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02553
Original file (PD-2013-02553.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02553
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20141107
SEPARATION DATE: 20031231


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCpl/E-3 (4641/Combat Photographer) medically separated for right foot condition. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was placed on limited duty and referred for a Medical Evaluation Board (MEB). The chronic plantar fasciitis, chronic Achilles tendonitis and Capsulitis 2nd metatarsal phalangeal joint right foot secondary to prior trauma conditions were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “capsulitis second metatarsal phalangeal joint right foot” rated at 10% and status post instep plantar fascial release right foot as Category II with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining condition , chronic Achilles tendonitis , was determined to be C ategory III condition . The CI made no appeals and was medically separated .


CI CONTENTION: “My condition was never diagnosed. The condition has been progressively getting worse and surgery is needed frequently to keep pain to manageable level.”


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 capsulitis second metatarsal phalangeal joint right foot condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 IPEB – Dated 20031103
 VA - (9 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Capsulitis Second Metatarsal Phalangeal Joint Right Foot 5399-5310 10% Right Second Toe Succession Surgery 5299-5283 0% 20040908
s/p Right Plantar Fascia Release CAT II Right Plantar Fasciitis 5399-5310 0% 20040908
Chronic Achilles Tendonitis CAT III Right Leg Pain Secondary to Achilles Tendonitis 5299-5271 20% 20040908
Other x 0 (Not in Scope)
 Other x 0
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 50128 (most proximate to date of separation )


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus 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 ratable severity at the time of separation.

Capsulitis Second Metatarsal Phalangeal Joint Right Foot Condition. The CI developed right foot pain during basic training in July 2000. Over the course of 2 years, she was diagnosed with Achilles tendonitis, plantar fasciitis and suffered a fractured bone, all in her right foot. She was evaluated with a magnetic resonance imaging study of the right ankle which was unremarkable. She underwent a bone scan which revealed findings consistent with plantar fasciitis of both feet; she had no symptoms in her left foot. In September 2001, she suffered a fractured second metatarsal in her right foot that required surgical correction. In November 2002, she underwent a surgical release of the right plantar fascia after her symptoms did not respond to duty limitation, medications, physical therapy, immobilization and custom orthotics.

The narrative summary (NARSUM) (prepared 4 months prior to separation) noted that although her post-operative course was uneventful, the final result was little improvement in symptoms. Due to the recurrent nature of the right foot pain and the CI’s difficulty with return to high impact activities, she was referred into the DES. The physical examination revealed marked tenderness along the surgical scar as well as the plantar medial tubercle of the calcaneus (consistent with an overuse injury of the plantar fascia). Tenderness was elicited at the base of the second toe in the region of the second metatarsophalangeal joint. The toe was also noted to be contracted at that level. The examiner made the following concluding statement:

“LCpl Turnage's foot condition does not interfere with her job requirements. She is unable to participate in high impact aerobic activities. Therefore, she does not participate in unit physical training or the run on the Marine PFTs. According to podiatry at Eisenhower Army Medical Center, LCpl Turnage's foot pain may improve when she adopts a more sedentary lifestyle, and she may require further medical care or surgery if her symptoms persist.”

At the VA Compensation and Pension (C&P) examination (performed 9 months after separation) the CI reported prior to surgery the pain level was 9/10 to 10/10. At that time, the pain level was 6/10. She used arch supports daily. Pain was present 1-2 times a month and there was no pain daily with walking. There was discomfort to touch daily, however. Also documented was that her Achilles tendonitis continued to cause her pain and that she was using a walking boot daily. If she walked without the boot, there was significant discomfort afterwards. She had not been able to run and standing was limited to 20 minutes. She did not use any medications for this. The physical exam revealed a very abnormal gait in that she attempted to walk without stretching her Achilles. Her gait was more normal with a walking boot. There was tenderness on the right plantar fascia with a 1 cm minimally tender scar from the plantar fascia release. The impression was, “Status post right plantar fascia release with intermittent recurrence of discomfort.”

The Board directs attention to its rating recommendation based on the above evidence. The PEB applied the analogous VASRD code of 5399-5310, Group X muscle function and rated the capsulitis second metatarsal phalangeal joint right foot condition at 10% disabling. The PEB also determined two other right foot diagnoses, right plantar fascia release and chronic Achilles tendonitis as Category II and Category III conditions respectively. The VA applied code 5399-5310 to the right plantar fascia condition and code 5299-5283 (malunion or nonunion of tarsal) or metatarsal bones), to the right second toe succession surgery and rated both 0%. The VA coded the chronic Achilles tendonitis as 5299-5271 (limitation of ankle motion) and rated it 20% disabling. The Board reviewed the evidence and members agree that the plantar fasciitis was the condition most responsible for the CI’s duty impairment at the time of separation. Comparing the pre-separation data with the post-separation C&P exam suggests that the CI’s Achilles tendonitis worsened after separation which would account for the VA’s rating scheme. In this case, VASRD code 5310 is most appropriate and represents the best coding option as the Group X muscle code includes “Other important plantar structures: Plantar aponeurosis, long plantar and calcaneonavicular ligament, tendons of posterior tibial, peroneus longus, and long flexors of great and little toes” in its rating guidelines as copied below:

5310 Group X. Function: Movements of forefoot and toes; propulsion thrust in walking. Intrinsic muscles of the foot: Plantar: (1) Flexor digitorum brevis; (2) abductor hallucis; (3) abductor digiti minimi; (4) quadratus plantae; (5) lumbricales; (6) flexor hallucis brevis; (7) adductor hallucis; (8) flexor digiti minimi brevis; (9) dorsal and plantar interossei. Other important plantar structures: Plantar aponeurosis, long plantar and calcaneonavicular ligament, tendons of posterior tibial, peroneus longus, and long flexors of great and little toes.
Severe ........................................................... 30
Moderately Severe ....................................... 20
Moderate ...................................................... 10
Slight ............................................................... 0

The data supports that her plantar fasciitis initially responded to surgical intervention but recurred when she returned to high impact activities. The NARSUM noted that her condition did not interfere with her job requirements but she was unable to perform high impact activities. Her commander recommended that she be retained on active duty in a permanent limited duty status. The Board notes that the rating options are subjective in nature and members agree that the CI’s impairment due to plantar fasciitis did not exceed the “moderate” level. The Board considered code 5284, other foot injuries, but the “moderate” rating for that code is also 10% and confers no benefit to the CI. 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 right foot condition.


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 capsulitis second metatarsal phalangeal joint right foot condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. 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 20131119, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




XXXXXXXXXXXXXX
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 8 Apr 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:
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN


                                                      XXXXXXXXXXXXXX
                                            Assistant General Counsel
                  (Manpower & Reserve Affairs)

Similar Decisions

  • 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 | 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 | CY2012 | PD2012 01755

    Original file (PD2012 01755.rtf) Auto-classification: Denied

    Ratings for unfitting conditions will be reviewed in all cases.The rated, unfitting condition of bilateral foot painas well as Raynaud’sphenomenon, low back pain (LBP), left knee retropatellar pain syndrome (RPPS), hemorrhoids, cervical dysplasia, pelvic pain, and bilateral wrist pain conditions as requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview.Any conditions or contention not requested in this application, or otherwise outside the Board’s defined...

  • 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 | 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 | CY2013 | PD-2013-01772

    Original file (PD-2013-01772.rtf) Auto-classification: Denied

    RECORD OF PROCEEDINGSPHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXXXX CASE: PD‐2013‐01772 BRANCH OF SERVICE: NAVY BOARD DATE: 20140624 SEPARATION DATE: 20040525 invalid font number 31506 SUMMARYOFCASE :...

  • 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 | CY2012 | PD2012-00311

    Original file (PD2012-00311.pdf) Auto-classification: Denied

    Post-Separation) – All Effective Date 20091016 ANALYSIS SUMMARY: The Board acknowledges the CI’s contention that suggests ratings should have been conferred for other conditions documented at the time of separation and therefore Service FPEB – Dated 20090528 Condition Code Severe Debilitating Plantar Fasciitis 5399-5310 Rating 10% ↓No Additional MEB/PEB Entries↓ Combined: 10% Condition Left Achilles Tendinopathy Neck Strain Chronic Low Back...

  • 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 | 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...