RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03849
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20030501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a reserve E5, Dental Technician, medically separated for “chronic pain and tendinosis of the left achilles tendon,” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.” 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 - 20030225	VARD - 20040511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain and Tendinosis of the Left Achilles Tendon	5024-5003	10%	Status Post Rupture, Left, Achilles Tendon	5299-5271	10%	20040224	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Pain and Tendinosis of the Left Achilles Tendon.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left ankle surgery in March 1998 for an acute rupture of the Achilles tendon.  The CI had not drilled with her unit for over 3 years due to her medical condition.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic pain” and “tendinosis, left achilles tendon, status post-surgical repair” for PEB adjudication.  

At an orthopedic clinic appointment in March 2002, 14 months prior to separation, the CI reported tenderness and intermittent swelling after prolonged use.  The examiner documented an intact Achilles tendon with normal function (Thompson test), and normal gait, dorsiflexion to 20 degrees and plantar flexion to 45 degrees.  The examiner opined that improvement was unlikely.  At a primary care visit in June 2002, 11 months prior to separation, the examiner documented “20 degrees of dorsiflexion lag on the left compared to the right,” after 2 weeks of physical therapy (PT) and recommended continuation of PT.  

At the MEB examination (documented on the Standard Forms 88 and 93) dated 16 March 2002, 10 months prior to separation, the examiner documented the ability to stand on toes, and equal bilateral calf strength against resistance.  The examiner opined that the CI was “fit for full duty.”  At two separate PT visits in September 2002, 8 months pre-separation, dorsiflexion was documented to 4 and 3 degrees, and plantar flexion was to 28 degrees.  

At the MEB NARSUM examination on 12 November 2002, 6 months prior to separation, the CI reported swelling and pain with standing more than 45-60 minutes; pain with walking or running, crawling, climbing, or walking over uneven terrain; and that she was unable to walk without a significant limp.  The physical examination showed normal strength and normal heel rise bilaterally.  There was tenderness at the Achilles tendon, and ankle dorsiflexion was to 5 degrees, and plantar flexion was to 35 degrees.  Radiographic studies were normal.  

At the 24 February 2004 VA Compensation and Pension (C&P) examination, performed 10 months after separation, the CI reported pain in the Achilles tendon and after prolonged walking.  The physical examination showed a normal gait and an antalgic squat.  Dorsiflexion was to 15 degrees and plantar flexion was to 45, with no evidence of laxity.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5024-5003 (tenosynovitis-arthritis, degenerative).  The VA rated the left ankle condition 10% coded analogously 5299-5271 (ankle, limited motion of: moderate) based on the VA C&P examination 10 months after separation, citing painful motion and limitation of motion.  The Board considered the evidence for a rating higher than 10%.  The evidence documented limitations of dorsiflexion, with normal or near normal plantar flexion, and normal or slightly antalgic gait.  Members agreed that the preponderance of the ranges of motion in evidence was more reasonably characterized as “moderate,” therefore supporting the 10% rating adjudicated by the PEB.  A higher rating of 20% was not indicated in the absence of marked, limited ROM of the ankle.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating, and provided no benefit to the CI.  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 ankle condition.  

BOARD FINDINGS:  In the matter of the “chronic pain and tendinosis of the left Achilles tendon” 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.  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, 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 11 Aug 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						 	 XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						 	(Manpower & Reserve Affairs)