RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01380
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Trainee, medically separated for “left chronic Achilles tendonitis…” with a disability rating of 10%.

CI CONTENTION:  The CI contends for his unfitting and not unfitting conditions, and other conditions not identified by either the MEB or PEB.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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 PEB - 20090507	VARD - 20100825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Chronic Achilles Tendonitis	5024	10%	Achilles Tendonitis, Left Foot	5276-5024	0%	20090902	
R Shoulder Impingement	Not Unfitting 	Status Post Right Shoulder Impingement	5201	0%	20090902	
R Knee Pain	Not Unfitting	Right Knee Patellar Tendonitls	5260-5024	0%	20090902	
R Hip Pain	Not Unfitting	Right Hip Trochanteric Bursitis	5252-50 19	0%	20090902	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Chronic Achilles Tendonitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s foot condition began in May 2007 during a unit run during Advanced Individual Training when he experienced sharp left ankle pain.  Left ankle magnetic resonance imaging showed chronic tear or healing tear of the Achilles tendon with a small amount of fluid near the attachment, with no evidence of a complete Achilles tendon tear.  At an orthopedic evaluation on 27 March 2008, the CI reported continued posterior left heel pain, aggravated by activity.  The examination showed a normal gait with normal foot alignment. The CI was able to stand on his toes.  There was tenderness to palpation (TTP) of the insertion of the AT, without obvious swelling or thickening of the tendon.  Magnetic resonance imaging (MRI) was normal, including a normal course and appearance of the Achilles tendon.  The orthopedic surgeon interpreted the MRI as showing no significant interstitial tearing of the AT, but some bursitis of the heel (retrocalcaneal bursa).  Surgery was discussed but there was no guarantee of significant improvement and the CI chose to continue conservative measures.  Despite treatment, the left ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “tendonitis, Achilles, left, chronic” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 19 December 2008, 8 months prior to separation, the CI reported constant left ankle stiffness and sharp pain.  The physical examination was limited to a check in the “normal” boxes for the lower extremities and feet 

The MEB NARSUM examination on 26 January 2009, 7 months prior to separation, noted complaints of constant left ankle pain, aggravated by weight bearing activities and improved by rest.  Physical examination showed a normal gait initially, with a minor left antalgic gait after range of motion (ROM) testing.  Ankle ROM was referenced, but ROM values were not found in record.  There was TTP of the Achilles tendon with pain when the ankle is “forcefully dorsiflexed.”  The NARSUM noted that tendonitis of the insertion of the Achilles tendon was confirmed on three MRIs.

At the 2 September 2009 VA Compensation and Pension (C&P) Joints examination, 1 week after separation, the CI reported left Achilles tendon pain.  The VA examiner noted the CI was able to “walk reasonable distances”, but he was not able to run, jog, or jump.  He did not require a cane or crutch for ambulation, but used an insert and heel lift in his shoe.  Physical examination showed a normal gait.  The CI was able to walk on his heels and toes, with “slight” pain in his left heel after heel walking.  There was TTP of the left AT, but no tightness, thickening, swelling, or discoloration.  The ROM of the ankles, feet, and toes were normal and pain free.  Ankle ROM was dorsiflexion 20 degrees (normal 20) and plantar flexion 50 degrees (normal 45).  Strength of the foot and toes was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5024 (tenosynovitis), citing painful motion (based on §4.10 and §4.59).  The VA rated the Achilles tendon condition 0%, coded 5276-5024 (acquired flat-foot-tenosynovitis), based on the C&P examination, 1 week after separation.  There was no limitation of ankle dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45).  The Board considered alternative VASRD ankle and foot codes, but all were less applicable and not advantageous to rating.  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 left chronic Achilles tendonitis condition.  

Contended PEB Conditions:  Right Shoulder Impingement, Right Knee Pain, and Right Hip Pain
The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  
BOARD FINDINGS:  In the matter of the “left chronic Achilles tendonitis” condition and IAW VASRD §4.71a, the Board unanimously or majority recommends no change in the PEB adjudication.  In the matter of the contended right shoulder impingement, right knee pain, and right hip pain conditions, 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.  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 20140315, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

27 JUL 2015

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 XXXXXXXXXXXXXXXXXXXX, AR20160011458 (PD201401380)

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 1 o, United States Code, section 1554a,
I accept the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA