RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00169
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030303

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “status post repair of rupture of left Achilles tendon” with a disability rating of 20%.  

CI CONTENTION:  The CI contends that his service rating should be changed because the Army only rated one of his many 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 - 20021125	VARD - 20030708	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Repair of Rupture of Left Achilles Tendon	5271	20%	Status Post Left Achilles Tendon Repair	5299-5271	10%	20030506	
Right Knee Pain	Not Unfitting	Right Knee Medial Meniscus Tear	5299-5257	10%		
Right Wrist, 3 Ganglion Cysts		Ganglion Cyst X2, Right Wrist	7819-7804	10%		
Bilateral Pes Planus		Bilateral Pes Planus	5276	10%		
Elevated Cholesterol		No VA Placement	
Seasonal Allergic Rhinitis		Allergic Rhinitis	6522	0%	20030506	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Status Post Repair of Rupture of Left Achilles Tendon.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left Achilles tendon rupture occurred on 6 September 2001 while participating in a flag football game.  The CI underwent surgery on 11 September 2001 for AT repair.  Following surgery the CI continued to have decreased ankle range of motion (ROM) and pain with tendonitis.  The MEB forwarded “left Achilles tendinosis…” for PEB adjudication.  

At the MEB Orthopedic Addendum evaluation on 8 May 2002 the CI reported chronic pain in the posterior leg and difficulty wearing shoes.  Left ankle ROM was dorsiflexion (DF) 0 degrees (normal 20 degrees) and plantar flexion (PF) of 20 degrees (normal 45 degrees).  The scar along the AT was well healed.  There was pain with single leg raise.  There was no evidence of nerve entrapment (negative Tinel’s), the AT was intact (negative Thompson sign) and lower leg strength was normal.  The left ankle decreased ROM and pain were determined to preclude adequate duty performance.  

At the MEB examination in July 2002, 8 months prior to separation, the CI reported left ankle surgery.   The physical exam showed a “bump” in the AT area.  The MEB NARSUM examination on 30 October 2002, 4 months prior to separation, noted complaints of left ankle pain.  The physical examination showed limited ankle ROM of DF 0 degrees (normal 20 degrees) and PF of 20 degrees (normal 45 degrees).  

At the 6 May 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported pain, weakness, stiffness, swelling, and fatigue.  He reported difficulty walking, standing and inability to run.  The physical exam showed a normal gait and posture.  There was a well healed scar over the left AT and normal appearance of the ankle.  Left ankle ROM was DF of 15 degrees and PF of 25 degrees, with painful motion noted.  Lower extremity strength, sensation, and reflexes were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition 20%, coded 5271(limitation of ankle motion), citing “marked” limitation of motion.  The VA rated the ankle condition 10% coded analogous to 5271, based on the VA C&P examination 2 months after separation, citing “moderate” limitation of motion.  

The PEB provided a 20% rating and the Board IAW DoDI 6040.44 cannot recommend a rating lower than that of the PEB.  There is no higher rating than 20% under 5271.  Therefore, the Board reviewed to see if there was a higher rating available with any applicable VASRD code.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 20% rating adjudicated by the PEB.  The Board also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7) however Board consensus was that the ankle impairment was not “severe,” supported by the observation of a normal gait at the VA C&P exam, 2 months after separation.  
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.  

Contended PEB Conditions:  Right Knee Pain, Right Wrist, Bilateral Pes Planus, and Seasonal Allergic Rhinitis.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  

The right knee pain condition was listed on the permanent L3 profile along with the left Achilles tendinosis condition.  However, the Orthopedic MEB addendum dated 15 August 2002, 7 months before separation, indicated that the CI had injured the right knee in January 2001 (approximately 26 months before separation).  He reported current intermittent right knee pain without locking or catching.  The knee ROM was considered full at 0 degrees extension to 120 degrees of flexion.  There was no effusion and no evidence of laxity or instability.  There was no joint line tenderness, no anterior knee pain, and no patellar or quadriceps tendon pain.  The MEB orthopedic examiner indicated that the CI’s knee injury did not “preclude him from his MOS tasks, physical training and completing a wartime mission, but his Achilles tendonitis would.”  The MEB NARSUM dated 30 October 2002, 4 months before separation, indicated that the right knee was “believed to be stable and medically acceptable.”  

The right wrist, bilateral pes planus, and seasonal allergic rhinitis conditions were not permanently profiled.  None of the contended conditions, including the right knee were 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 status post repair of rupture of left Achilles tendon”condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right knee pain, right wrist, bilateral pes planus, and seasonal allergic rhinitis 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 20150127, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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 
XXXXXXXXXXXXXXXXXX, AR20160018505 (PD201500169)

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, 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