RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2015-01932
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20050302

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Basic Airman, medically separated for “chronic right Achilles tendon pain,” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  The 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 - 20050216	VARD - 20050917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Achilles Tendon Pain	5024	10%	Residuals of Right Achilles Tendon Tear	5099-5024	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Achilles Tendon Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right Achilles tendon condition began in July 2004 after 1 week of Basic Training without specific injury.  Magnetic resonance imaging studies on 20 August 2004 showed an early longitudinal partial tear of the right Achilles tendon, along with tenosynovitis.  At the time of the orthopedic clinic appointment on 29 November 2004, the CI reported pain primarily with walking activities.  On examination she had full ankle and hind foot range of motion (ROM) and pain with passive ankle dorsiflexion.  She also had tenderness near the Achilles insertion.  Orthopedics concluded with a diagnosis of non-insertional Achilles tendonitis.  Evaluation by Podiatry on 25 January 2005 noted the CI’s Achilles tendon was tender but intact.  She was diagnosed with chronic right Achilles tendonitis.
The 1 February 2005 MEB NARSUM examination, 1 month prior to separation, noted complaints of right Achilles tendon tenderness to palpation without palpable deformity.  Strength was 5/5 (normal).  The tendon was not ruptured but the CI was noted to have a mildly antalgic gait.  There was no VA Compensation and Pension examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right Achilles tendon condition 10%, coded 5024 (tenosynovitis).  The VA rated the right Achilles tendon condition 0%, coded 5099-5024 (tenosynovitis) based on the STR, citing a lack of objective evidence of painful or limited motion of a major joint or group of minor joints.

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 (§4.59) supporting a 10% rating.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  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 right Achilles tendon condition.  

BOARD FINDINGS:  In the matter of the right Achilles tendon condition and IAW VASRD §4.71a, the panel 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 modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150711, w/attachments
Exhibit B.  Service Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01932.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings