RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04057
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060425

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Artilleryman, medically separated by the Informal Physical Evaluation Board (IPEB) for a “left Achilles tendon rupture,” with a disability rating of 0%.

CI CONTENTION:  The CI was not evaluated for his PTSD, sleep apnea and hearing loss.  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 - 20060210	VARD - 20070306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Achilles Tendon Rupture	5024	0%	Left Achilles Tendon Rupture, Status Post (S/P) Surgical Repair	5271-5311	0%	20060721	
			Swelling of Scar, Left Achilles Tendon, Left Achilles Tendon Rupture, S/P Surgical Repair	7899-7804	10%	20060721	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Achilles Tendon Rupture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in March of 2004 during physical training while deployed to Iraq.  He was air evacuated to Landstuhl where he was diagnosed with a left Achilles tendon rupture.  He subsequently underwent operative repair.  Post-operative examination revealed excessive dorsiflexion, and he underwent a left Achilles shortening in May of 2005 with no improvement of symptoms.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left Achilles rupture with continued pain and weakness” for PEB adjudication.  

During the MEB examination dated 8 December 2005, 5 months prior to separation, the CI reported left ankle pain and weakness.  Physical examination showed a normal gait, a well-healed surgical scar, and tenderness over the left Achilles tendon.  Goniometer measured bilateral ankle range-of-motion (ROM) was 15 (20 normal) degrees of dorsiflexion and 40 (45) degrees of plantar flexion.  At the 21 July 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported weakness and inability to bear weight on his toes.  Physical examination showed a normal gait and a well-healed surgical scar, swelling, and tenderness over the left Achilles tendon.  Left ankle ROM was 10 (20) degrees of dorsiflexion and 45 (45) degrees of plantar flexion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, coded 5024 (tenosynovitis), citing residual mild weakness of ankle flexion and chronic pain.  The VA rated the left ankle condition 0%, coded 5271-5311 (ankle, limited motion of-foot and leg muscle code), citing a non-compensable evaluation base upon a slight muscle disability.  The VA also assigned a separate 10% rating for painful scar.  The Board reviewed the STR and did not find evidence that a tender or painful scar separately interfered with duty, or imposed a direct limitation on fitness, and therefore a separate rating was not recommended.  The ROM values documented in the proximate examinations (MEB and C&P) were essentially normal and did not support a minimal rating under 5271 (ankle, limited motion of).  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 to support a 10% rating considering VASRD §4.40 (functional loss) and §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left ankle condition, coded 5024.

BOARD FINDINGS:  In the matter of the left ankle 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.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Achilles Tendon  Rupture 	5024	10%	

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 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 AR20160013675 (PD201404057)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA