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AF | PDBR | CY2013 | PD-2013-02782
Original file (PD-2013-02782.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02782
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20150211
SEPARATION DATE: 20070531

invalid font number 31502
SUMMARY OF CASE: Data extracted for the available evidence of record reflects that this covered individual (CI) was an active duty E-3 ( Basic Aircraft Maintenance Marine ) medically separated for bilateral plantar fasciitis (PF). The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards. He was placed on light duty and referred for a Medical Evaluation Board (MEB). The bilateral foot condition, characterized as “bilateral plantar fasciitis,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated the bilateral PF, left greater than right, rated 10% and 0% respectively, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “I originally developed plantar fasciitis in my left foot. It has in turn also moved to my right foot, both knees and hips are affected. Also my back is affected because of the loss of my arch.”


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 :

Service IPEB – Dated 20070411
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Plantar Fasciitis, Left Greater Than Right 5399-5310 10% Bilateral Plantar Fasciitis 5299-5276 10% 20070817
5399-5310 0%
Other x 0 (Not in Scope)
 Other x 3 20070817
Rating: 10%
 Combined: ##%
Derived from VA Rating Decision (VA RD ) dated 20100127 .


ANALYSIS SUMMARY:

Bilateral Plantar Fasciitis Condition. The narrative summary (NARSUM) noted the CI was diagnosed by a podiatrist with bilateral PF, left greater than right. The NARSUM noted the CI had 9 months of active duty and was on light duty for 5 months for his foot pain. Notes in the service treatment record indicated the CI was in a motorcycle accident as a teen and sustained a bimalleolar fracture of his left ankle requiring open reduction and internal fixation with a plate and screws and the hardware was later removed. At a primary care visit on 19 September 2006 the CI reported being asymptomatic until he stepped in a “rut” during a march and injured his left foot. The CI reportedly developed pain in his left hip, knee and foot. Examination noted a normal gait and stance. Bilateral flatfoot was noted, left greater than right and there was tenderness of the plantar fascia and first metatarsal of the left foot. Radiographs of the knee and femur were reportedly normal and the examiner commented that the knee and hip pain may be related to the foot findings. The CI was placed on a temporary profile for flatfoot and referred to physical therapy and podiatry. The evaluation by the podiatrist on 5 October 2006 also noted bilateral flatfoot, left greater than right, and tenderness to palpation (TTP) of the bottom of both feet and tenderness with range-of-motion and diagnosed flat foot and PF. Treatment of the CI’s LLE pain included a period of limited weight bearing with crutches, orthotics, and medications without improvement in the foot pain and the podiatrist recommended a MEB for left PF.

At the MEB examination on 26 January 2007, 4 months prior to separation, the CI reported bilateral foot pain. The MEB physical exam noted an antalgic gait favoring the LLE. There was normal ROM of the foot and ankle. There was TTP of the heel and PF, left greater than the right. A mild valgus deformity of both feet was noted on exam and confirmed by X-rays.

At the VA Compensation and Pension exam performed 3 months after separation, the CI reported daily aching pain from mid-heel to the back of his feet. He reported use of anti-inflammatory medication, but no orthotics. The examiner noted that the CI changed jobs due to foot and knee pain, but was employed in sales and did not miss work. The exam noted a normal gait with normal LE muscle strength, sensation, and reflexes. Bilateral flatfoot was noted with tenderness of the mid-heel and mild pronation. Weight bearing was not over or medial to the great toe and there was normal foot alignment without tenderness of the Achilles tendon. Bilateral foot X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence. The PEB listed a bilateral PF condition, left greater than right, but indicated separate rating for each foot of 10% and 0%, respectively (combined 10% rating), both coded 5399-5310 (analogous to muscle Group X- analogous code for PF). The VARD dated 27 January 2010 rated the condition 10% rating, effective on 19 May 2007, coded as 5299-5276 (analogous to acquired flatfoot). The PEB rated the left foot disability as “moderate” and the right foot as “slight” IAW §4.73 (muscle injuries). Members agreed that this description of the disability of each foot accurately reflected the evidence in record and agreed with the PEB’s assigned ratings as coded, with a combined rating of 10%. The Board reviewed to see if a higher rating was achieved for either the left or right foot, or both, alternatively rating IAW §4.71a (musculoskeletal conditions). The Board first considered coding analogously to bilateral acquired flatfoot, but the evidence supports the bilateral foot condition met the 10% rating for pain on manipulation and use of the feet, whether bilateral or unilateral and did not meet the next higher evaluation of 20% for unilateral severe flatfoot with marked deformity and swelling with use and characteristic callosities. The Board next reviewed coding as 5284 (other foot injury) and noted the rating criteria are subjective with a threshold of “moderate” foot injury for a 10% rating, comparable to the 5301 rating criteria. In this case, Board consensus was that coding as 5284 would also provide a 10% rating for the left foot and a 0% rating for the right foot IAW §4.31 (0% evaluations). Thus, the Board concluded that the evidence supports a 10% combined rating for the foot conditions with multiple codes, but that a higher evaluation for either foot, or the combined rating was not achieved with any coding approach. 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 bilateral PF 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 bilateral PF condition and IAW VASRD §4.73, 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 20131217, w/aches
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) RECOMMENDATION
Ref:     (a) DoDI 6040.44
(b) CORB ltr dtd 16 Jun 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:

-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USN
-        XXXXXXXXXXXXXXXXXXXX, former USMC
-        XXXXXXXXXXXXXXXXXXXX, former USMC






XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)

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