RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01294
BRANCH OF SERVICE:  Army	BOARD DATE:  20150108
SEPARATION DATE:  20040826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11B/Infantryman) medically separated for left Achilles tendonitis.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent L3 and referred for a Medical Evaluation Board (MEB).  The left Achilles tendonitis condition, characterized as “chronic left Achilles tendinitis secondary to shrapnel injury” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “left Achilles tendonitis” as unfitting, rated 0%, with likely application Department of Defense Instruction (DoDI) 1332.39.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I constantly have pain, excruciating pain.  I have them in my L/leg, ankle, and the bottom of my feet.  My lower back aches continuously.  I cant walk too long without stopping.  I can’t stand up for an extended period of time.  I am only getting 30%.  I feel and know I should be receiving 100% for the pain and agony I go through on a daily basis.  I am not satisfied with that rating at all.  I feel it’s a slap in my face, insulting for all I have done as an Infantryman in the US Army.”  

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 left Achilles tendonitis condition is addressed below; 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 Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040506	VA - (10 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Achilles Tendonitis	5024	0%	Achilles Tendonitis, Left	5099-5024	10%	20050617	
Other x 0 (Not in Scope)	Other x 4		
Combined:  0%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20050709 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Achilles Tendonitis Condition.  The CI‘s history revealed that he developed left lower extremity pain in October 1997 during training after a grenade exploded 7-8 meters away from him.  At the time of the incident, grenade fragments made contact with his left buttock and leg.  Radiographs were normal, except for the identification of a metallic foreign body overlying the midsection of the tibia.  Treatment records were silent going forward until August 2002, when the CI presented to the medical clinic with the report of lower left leg pain during exercise and during increased activity.  In March 2003, the CI underwent consultation with orthopedics and was diagnosed with left Achilles tendonitis secondary to shrapnel.  The physician recorded the CI had a P2 profile in place; however, he was requesting an MEB secondary to chronic Achilles pain.  The P2 profile remained in place until early January 2004, updated to P3 on 28 January.  Orthopedic examination dated 2 March 2004 recorded left leg tenderness to palpation, ankle with full range-of-motion (ROM), muscle strength of 5/5 with some pain and no evidence of neurovascular compromise.  Last radiographs on 19 March 2004 demonstrated the presence of the shrapnel (4mm, mid tibia) with no evidence of compromise to the bony structure.  The MEB narrative summary (NARSUM) dated 7 April 2004, approximately 4 months prior to separation, recorded CI reported he was unable to perform 3-5 second rushes and rucksacking, had minimal running ability, was unable to march in formation, and noted tinkling pain, and some numbness in his leg exacerbated by prolonged standing and increased activity.  The physician noted the CI underwent consultation with orthopedic and physical therapy services, and there was no “further surgical interventions” (no evidence of any surgery) or treatment available that would relieve his symptoms.  Physical examination of the left lower extremity recorded the presence of a scar near the musculotendinous junction of the Achilles tendon with tenderness to palpation.  There was evidence of mild muscle (gastrocnemius) atrophy secondary to his injury.  He was able to perform a single leg toe raise on the left (intact tibial tendon) with difficulty, and the Achilles tendon was intact.  He had full ROM of the ankle bilaterally.  His condition was judged to be stable.  At the VA Compensation and Pension examination, approximately 10 months after separation, the CI noted he had not undergone any surgeries to remove fragments.  He had pain on walking greater than 15 minutes and with standing more than 15-20 minutes.  He was not on any medications and did not use a brace.  Physical examination noted a normal gait and posture and no evidence of musculoskeletal pathology or neurovascular compromise.  The examiner noted the presence of the scar in the area of the Achilles that reached down to the tendon that was tender only on deep palpation, and demonstrated no loss of tissue.  Left ankle ROM was decreased slightly (dorsiflexion of 10 [20], plantar flexion of 30 [45]).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 0%, coded 5024 (tenosynovitis) and noted the absence of limitation of motion.  The VA rated the condition at 10%, coded analogously 5024 (limitation of motion).  A rating of 10% under this code requires evidence of limitation of motion or identification of arthritis, which was not supported by the evidence at the time of separation.  There were no other applicable codes to consider for a compensable rating.  The Board considered the application of the VA Schedule for Rating Disabilities (VASRD) § 4.40 (functional loss), and all members agreed the condition was compensable under this provision since the NARSUM documented decrease muscle size secondary to the injury and led to decrease ability to perform the basic physical tasks associated with meeting requirements of his MOS.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% IAW VASRD §4.40 for the left Achilles 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 left Achilles tendonitis condition, the Board unanimously recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Left Achilles Tendonitis	5024	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150007430 (PD201301294)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl			    

CF: 
(  ) DoD PDBR
(  ) DVA