RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01995
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20050615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Seaman, medically separated for status post left Achilles tendon rupture with surgical repair.  The 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 (LIMDU) and referred for a Medical Evaluation Board (MEB).  The “status post left Achilles tendon rupture with surgical repair” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “status post left Achilles tendon rupture with surgical repair” as unfitting, rated 10%, citing application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.   

CI CONTENTION:  “The injury sustained does not fit the rating given.  The injury completely altered my lifestyle.  I’m a very active person, however after the injury; and secondary conditions my life style has changed.”  

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 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 20050228	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Left Achilles Tendon Rupture With Surgical Repair	5099-5003	10%	Residual Status Post Achilles Tendon Repair	7899-5271	10%	20050405	
Other x 0 (Not In Scope)	Other x 7 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050420 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:

Left Ankle.  The Service treatment record (STR) documented that the CI sustained a left Achilles tendon rupture while playing basketball on 24 March 2004.  The CI presented to the emergency department on 24 March 2004; left ankle X-ray showed questionable inflammatory changes about the Achilles tendon.  The 25 March 2004 orthopedic surgery consultation diagnosis listed left Achilles tendon rupture with a plan for surgical repair.  On 31 March 2004 the CI underwent a surgical repair of the left Achilles tendon rupture.  The 12 August 2004 physical therapy left ankle exam documented good incision healing, no erythema (redness), no ecchymosis (bruising), and no antalgic (assuming a gait or posture to lessen pain) gait.  Left ankle range-of-motion (ROM) showed 10 (normal 20) degrees of dorsiflexion, 45 (normal 45) degrees of plantar flexion, 20 degrees of inversion, and 20 degrees of eversion.  The narrative summary, 4 months prior to separation, recounted the history and interventions to date.  The CI complained of sharp pain in the Achilles tendon region and a cramping sensation right above the surgical repair site.  She had difficulties walking long distances and standing or sitting for any period of time.  The CI had not been able to return to her usual level of exercise or activity.  The physical exam revealed she ambulated with a steady, non-antalgic gait.  The lower extremity exam showed a well healed surgical scar over the Achilles tendon with some keloid (abnormal/excessive scar tissue proliferation) formation.  The Achilles tendon was mildly tender to deep palpation.  Palpation of the Achilles tendon revealed no discontinuity and the Thompson test (assesses integrity of Achilles tendon) was negative.  There was no ligamentous laxity with provocative testing (no instability of the anterior drawer on forced inversion).  There were no sensory deficits and the distal neurovascular status was intact.  Left ROM showed 5 (normal 20) degrees of dorsiflexion, 30 (normal 45) degrees of plantar flexion, 30 degrees of inversion, and 15 degrees of eversion.  The diagnosis listed status post left Achilles tendon rupture with surgical repair.  

The Compensation and Pension (C&P) exam, 2 months prior to separation, recounted the history and interventions to date.  The CI complained of "Constant pain, cramping, sharp pain, and limited flexibility."  The symptoms resulted in "a limp with walking, difficulty squatting, and pain with standing, walking running, climbing stairs, and walking on inclines."  She reported an associated loss of strength, weakness, easy fatigability, and impairment of coordination.  The physical exam revealed the CI ambulated with an abnormal gait where she favored the right foot.  She did not require an assistive device for ambulation, leg length was equal, and the feet did not show any signs of abnormal weight bearing.  The left ankle exam showed a posterior scar over the Achilles tendon and tenderness with palpation at the repair site.  Lower extremity motor function, sensory function, and deep tendon reflexes (2+) were within normal limits.  There were signs of lowered endurance, including painful plantar flexion on the left side, with inability to stand on tiptoes.  Left ankle ROM showed 20 (normal 20) degrees of dorsiflexion and 45 (normal 45) degrees of plantar flexion.  The left ankle ROM was additionally limited, following repetitive use, by pain, fatigue, weakness, and lack of endurance.  The ROM was not additionally limited, following repetitive use, by incoordination.  Pain had the major functional impact.  The diagnosis listed status post Achilles tendon tear with repair with postoperative chronic tenosynovitis. 

The Board directed its attention to its rating recommendation based on the above evidence.  The informal PEB rated the left ankle condition 10% (VA code 5099-5003; rating by analogy-degenerative arthritis).  The PEB cited status post left Achilles tendon rupture with surgical repair.  The VARD, citing the C&P exam 2 months prior to separation, rated the left ankle condition at 10% (7899-5271; rating by analogy-ankle, limited motion of:  moderate).  The VARD cited painful motion, full ROM, ROM additionally limited following repetitive use by fatigue, weakness, and lack of endurance, and a surgical scar.  Board members agreed that the ankle limitation of motion (5271) in the MEB exam more closely approximated the moderate (10%) than the marked (20%) rating.  The ankle limitation of motion in the more proximate C&P exam did not attain a minimum rating under 5271.  The Board assigned the most probative value to the C&P exam, 2 months prior to separation, as accurately reflecting the CI’s condition at the time of separation.  There was no deformity for consideration under 5270 (ankle, ankylosis), 5272 (subastragalar or tarsal joint, ankylosis of), or 5273 (os calcis or astragalus, malunion of).  There was no excision of the astragalus for consideration under 5274 (astragalectomy).  Board members agreed that there was sufficient evidence of pain with use prior to separation, as well objective exam and imaging findings, to support a 10% rating considering functional loss and painful motion (§4.40, §4.59).  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 left ankle 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 ankle 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 20131029, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 1 Dec 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:

- XXXXXXXXXXXXXXXXXXX, former USMC  
- XXXXXXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXX, former USN