RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02164
BRANCH OF SERVICE:  NAVY	Date of sepAration:  20080619

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Aviation Electronics Technician, medically separated for “right, painful accessory, navicular, status post modified Kidner procedure, with a disability rating of 10%. 

CI CONTENTION:  The CI states that he received a rating of 90%.  His 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 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 PEB - 20080117	VARD - 20090105 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right, Painful Accessory, Navicular S/P …Procedure	5299-5279	10%	Posterior Tibial Tendonitis Bilateral feet with Plantar …	5284	10%	20080725	
			Right Ankle Condition	      5271	    0% 	20080725	
Right Gastroc Equinus  	Cat II	No VA Placement	
Bilateral Patellofemoral Pain syndrome	Cat III	NO VA Placement	
RATING:  10%	RATING:  20%	

ANALYSIS SUMMARY:  

Right Foot Pain (including right gastroc equinus).  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgery to remove an accessory bone from the foot and revision of an adjacent tendon (aka…Kidner procedure) in July 2007.  Post-operative X-rays revealed intact hardware and degenerative changes about the right hind foot/ankle.  At the MEB narrative summary (NARSUM) dated 27 November 2007, 5 months prior to separation, the CI endorsed continued right foot pain.  His physical examination (PE) revealed a tenderness about the inside of the right ankle.  There was no documentation of ankle range of motion (ROM) after the surgical intervention.  At the VA Compensation and Pension (C&P) examination dated 25 July 2008, 3 months after separation, the CI reported continued foot pain worsened with prolonged walking and or standing.  His PE revealed a normal posture and gait.  There was tenderness about the right ankle.  Ankle ROM was normal, but painful.       

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10% (analogously coded 5279 [metatarsalgia]), citing no specific criteria.  The VA rated both feet together under the diagnosis of tendonitis and plantar fasciitis utilizing code 5284 (foot injuries; other) at 10% (moderate) impairment.  

Board members considered and agreed that either code used by the PEB and or the VA in this case was appropriate.  The analogous PEB code of 5279 allows for a single rating of 10% applied either unilaterally or bilaterally.  The 5284 code is a unilateral code with a three-tiered rating level of 10% (moderate), 20% (moderately severe), and 30% (severe) impairment.  All members agreed that the documented painful motion and tenderness about the right ankle coupled with normal ROM would rate no greater than 10% (moderate) impairment under VASRD code 5284, equaling the PEB’s current and sole rating of 10% under primary code of 5279.  Therefore, 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 disability rating for the right foot pain condition. 

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the bilateral PFPS was not unfitting.  The NARSUM addendum (28 November 2007) specific for bilateral knee pain was cursory and without history of prior injury and or surgery; whereas the VA examination dated 29 July 2008 (3 months after separation) contained a detailed history of bilateral knee pain and a two-tiered ligament repair surgery performed on the left knee in 2000. 

The CI endorsed being independent in activities of daily living (ADLs) and ambulated with no assistive devices.  Additionally, he endorsed the inability to do certain sports like baseball and football.  Under an additional VA examination for a separate foot condition it noted that “…he believes his foot pain does limit his opportunities for employment and also prevents him from running, playing baseball, football and basketball.”   

The PE revealed braces (type-unspecified) on both knees.  There was tenderness about both knees.  There was bilateral crepitation; left > right.  Bilateral knee ROM was full, but painful.  Instability maneuvering tests were negative.  The VA diagnosis was listed as bilateral chronic knee pain syndrome with PFPS and chondromalacia of both patella.

Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that the CI’s own admission of performance inabilities as being caused from conditions other than their knees clearly supported that the bilateral PFPS was appropriately categorized in this case.     

BOARD FINDINGS:  In the matter of the right foot condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral PFPS condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20140325 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 31 May 16

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

					XXXXXXXXXXXXXXXXXXXX	     				  	Assistant General Counsel
					(Manpower & Reserve Affairs)