RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01281
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Equipment Operator, medically separated for “status post tarsal tunnel release,” with a disability rating of 20%.  

CI CONTENTION:  The CI submitted a lengthy contention for his unfitting condition that includes a request to review the nerve damage associated with condition.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20070212	VARD - 20070606	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Tarsal Tunnel Syndrome	5299-5262-8625	20%	Tarsal Tunnel Syndrome Right Foot	8525	10%	20070323	
Chronic Right Ankle Pain	Cat 2	S/P Right Ankle Fracture, Open Reduction and Internal Fixation	5271	20%	20070323	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

S/P Tarsal Tunnel Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic right ankle pain condition began in 1999.  The CI fractured his ankle during physical fitness training and underwent open reduction and internal fixation (ORIF) of a fracture of the fibula and the hardware was removed in 2001.  The CI continued to have ankle pain and was treated with therapy, injections, and medications but medial ankle pain persisted.  Electrodiagnostic (EMG/NVC) studies in March 2005 showed right tarsal tunnel (TT) syndrome and the CI underwent surgery for TT release on 14 July 2006.  Following the surgery the CI initially improved, but ankle pain with a burning sensation of the leg and numbness of the sole of the foot returned and repeat EMG/NCV studies showed persistent or recurrent TT syndrome.  At a follow-up surgical visit on 22 March 2007, the physical examination showed a well healed incision with neutral foot and arch alignment.  Right ankle range of motion (ROM) was dorsiflexion (DF) of 10 degrees (normal 20) and plantar flexion (PF) of 30 degrees (normal 45).  Strength, reflexes, and pulses were normal.  There was a positive Tinel’s sign (pain, numbness, tingling in the nerve distribution with percussion) at the TT.  The CI’s surgeon noted the persistent abnormal EMG/NCV studies and indicated the nerve damage was permanent.  

The MEB NARSUM examination on 28 December 2006, 8 months prior to separation, noted complaints of chronic ankle pain.  Physical examination showed tenderness over the surgical scar and the inner aspect of the ankle and there was a positive Tinel’s sign over the surgical scar.  The CI’s ankle ROM was “severely limited due to…pain.”   There was decreased sensation of the plantar surface of the right ankle and surgical scar.  Vascular function was intact.  The MEB NARSUM examiner summarized that imaging studies showed the ankle fracture was well healed and the ankle joint was intact without evidence of degenerative changes.  A CT scan showed mild degenerative changes of the subtalar joint.  The MEB NARSUM examiner determined the CI was not fit for full duty due to ongoing ankle pain.  

At the 23 March 2007 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported right ankle pain with weakness, stiffness, swelling, lack of endurance and locking.  The pain was constant and radiated to the right leg and foot with tingling in the right foot.  The CI reported he could function with the pain without medication and denied any period of incapacitation in the past year.  He reported he was unable to run or drive a car, or stand or walk for prolonged periods of time.  He reported difficulty with stair climbing and some household and yard work activities due to the right ankle pain.  Physical exam showed the CI walked with a normal, steady gait without use of an assistive device.  There were two scars on the ankle that were tender, but did not cause limitation of motion or functional limitation.  Right ankle exam noted limited, painful ROM.  There was diffuse tenderness without swelling, joint effusion, weakness, abnormal movement or guarding of movement.  There was no evidence of instability of the ankle.  Ankle DF was 5 degrees and PF was 10 degrees and there was no additional loss of ROM with repetitive ROM.  There right foot was painful on the bottom of the foot.  There were no foot or toe deformities.  There was no painful motion, swelling, or evidence of disturbed circulation.  Strength and reflexes of the lower extremities were normal.  There was decreased sensation to pinprick in the lateral aspect of the right foot.  Right ankle X-rays noted old post-traumatic changes with no other significant findings.  Right foot X-rays noted no significant findings.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “status post tarsal tunnel release” condition 20%, coded analogously to 5262-8625 (posterior tibial nerve [PTN] neuritis with fibular impairment).  The PEB also adjudicated chronic right ankle pain as a related Category II condition.  In this case, the Category II condition refers to the same disability as the unfitting Category I condition and is not separately ratable IAW VARSD §4.14 (Avoidance of pyramiding).  The VA rated the TT syndrome 10%, coded 8525 (PTN, incomplete paralysis) for decreased sensation and normal strength and also rated the right ankle status post fracture and ORIF 20%, coded 5271 for painful, marked limited ROM.  

The PEB assigned a 20% rating under 8625 for “severe” neuritis of the PTN.  This is the highest VARSD rating assignable for PTN neuritis IAW VARSD § 4.123 and §4.124a.  There was no evidence of complete paralysis of the PTN for a higher rating coded as 8525 (complete paralysis PTN) based on the evidence at the pre-separation VA examination, the examination most proximate to separation.  At the VA examination the CI had a normal gait, with normal strength of the lower extremities, and no abnormalities of the right foot were noted on exam, other than tenderness of the bottom of the foot.  Dual ratings under both 8625 and 5271 could not be recommended by the panel for the TT syndrome IAW VASRD §4.14.  However, the panel considered if alternatively rating the CI’s disability due to the TT syndrome based on limited ankle ROM supported a higher rating, but the highest rating under 5271 is also 20%.  There is therefore no higher rating than 20% available under any applicable VARSD code.  The PEB utilized a triple code which was not VASRD compliant, however, there is no ratings benefit to the CI to a coding change and therefore no change to the PEB’s adjudication is recommended.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the “status post tarsal tunnel release” condition.  

PANEL FINDINGS:  In the matter of the “status post tarsal tunnel release” condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150615, 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 10 May 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXX