RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00518
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030404

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Track Vehicle Repairer, medically separated for “chronic right Achilles pain,” with a disability rating of 10%.  

CI CONTENTION:  “Because I’ve been having problem with that leg since I got hurt.  My calf muscles has never come completely back.  I never got my 10%.”  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 - 20030107	VARD – 20040311 & 20040715	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Achilles Pain	5099-5003	10%	Status Post Repair Right Tendon Achilles Rupture	5284	0%	20030714	
			Right Calf Muscle	5311	0%	20040322	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Achilles Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in April 1999 when another soldier stepped on his heel while playing basketball.  The CI underwent ankle surgery 25 April 1999 for ruptured tendon.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right Achilles pain” for PEB adjudication.  

The MEB NARSUM on 4 November 2002, 5 months prior to separation, noted the CI reported persistent heel pain around the surgical site and that he wore an ankle/foot orthoses because of his pain.  The MEB physical examination noted his sensation was intact to light touch and had a well healed scar.  There was decreased bulk and tone of his right calf and the CI was unable to single heel raise on that side.  He had full range of motion (ROM) of his ankle with pain.  

At the clinic visit dated 13 December 2002, the CI complained of pain with cramping and spasm of the right calf.  The CI was using a cane and ankle brace.  Ankle ROM was good and there was gastrox tenderness and mild atrophy.  

At the 14 July 2003 VA Compensation and Pension (C&P) examination, performed 3 months after separation, the CI reported pain in the posterior aspect of his right leg with weakness in his right calf.  He had pain with walking, which interfered with his ability to perform his job or household duties.  Physical examination showed a normal gait.  The CI’s ROM measurements were dorsiflexion of 20 degrees (normal 20 degrees), and plantar flexion of 45 degrees (normal 45 degrees), without complaint of pain.  No crepitus with motion was noted.  There was “some weakness” in the right calf, with inability to do a one-legged toe stand, but retained ability to walk on toes without difficulty.  There was a well-healed surgical scar.  The Achilles tendon was intact as was the foot.  The CI wore an ankle air cast to the examination which the examiner stated was for mediolateral protection of the ankle, and that the CI did not wear anything to splint the Achilles tendon.  

At the 22 March 2004 VA C&P examination, performed 12 months after separation, the CI reported right calf and ankle pain with moving his ankle back and forth with driving.  The CI reported using a cane with walking long distances and the CI wore “a medial-lateral air (the type used to treat sprained ankles) which provides only medial-lateral stability.”  Physical examination showed a normal gait.  There was tenderness in the calf and over the Achilles tendon.  There was no vascular, sensory or motor deficit.  ROM of the ankle was full and painless with no incoordination, pain, or change on repetition.  The right calf was 1 cm smaller in circumference (atrophy) than the opposite side.  

The Board directed attention to its rating recommendation based on the above evidence.  The Formal PEB rated the right ankle condition 10%, coded analogously to 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA rated the right ankle condition 0%, coded 5284 (foot injuries, other), citing the absence of ‘moderate’ symptoms associated with a foot injury.  The VA also rated the right calf muscle condition 0%, coded 5311 (Group XI Muscles), citing “slight” muscle disability.  

There was no limitation of 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) on the NARSUM examination.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints, no malunion of the os calcis (calcaneus) or astragalus (talus) or astragalectomy for consideration under the respective diagnostic codes (5270, 5272, 5273 or 5274).  The Board also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7); however, all Board members agreed that the impairment did not more nearly approximate moderately severe (20%) to support a higher rating.  There was insufficient evidence that calf muscle weakness rose to the level of being separately unfitting at 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 right ankle condition.  
BOARD FINDINGS:  In the matter of the chronic right Achilles pain 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 20150502, w/attachments
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 XXXXXXXXXXXXXXXXXXXX, AR20160014795 (PD201500518)

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