RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02015
BRANCH OF SERVICE:  mARINE cORPS 	SEPARATION DATE:  20061015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Marine, medically separated for left “posterior tibial tendon injury” 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 - 20060918	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Posterior Tibial Tendon Injury	5311	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Left Posterior Tibial Tendon Injury.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered an inversion injury to her left ankle in June 2006 (4 months before separation).  Radiographic studies demonstrated a partial tear of the posterior tibial tendon.  There was no surgical indication.  There were multiple STR entries that documented grossly normal range of motion (ROM) of the foot and ankle, with no entries to the contrary.  Earlier STR entries noted painful motion, but later ones specified the absence of painful motion.  Several entries recorded a normal gait, and there were none to the contrary.  There was STR confirmation of joint stability and the absence of any foot deformity.
  
The 23 August 2006 NARSUM examination, 2 months before separation, documented that the CI was ambulatory in a custom ankle brace with “pain after 3 to 5 minutes of walking,” standing limited to 15 minutes, and no running.  The physical examination recorded tenderness (navicular) but no swelling, full strength (able to heel raise), and intact neurovascular findings.  There were no ROM measurements and no comments regarding painful motion.  The NARSUM podiatrist opined that the CI was anticipated to “return to full function 6 months post injury,” but still would be unable to tolerate the physical demands of an active duty Marine.  

The 13 September 2006 podiatry examination, 1 month before separation, documented all normal findings; e.g., normal foot and ankle without swelling or tenderness, and full painless ROM.  Ambulatory status and gait were not elaborated.  There was no VA claim, examination, or clinical notes on file; and, there was no other post-separation evidence in this case.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5311 (the Group XI muscle disability code that encompasses the posterior tibialis) did not cite a rationale; although, the 10% criterion of 5311 is “moderate” disability.  Code 5311 also offers ratings of 20% for “moderately severe” and 30% for “severe” disability.  Analogous rating under code 5284 (foot injuries, other) would offer an equivalent scale for rating functional disability.  

There was no evidence of limitation of motion or any other ratable criterion that would justify a rating higher than 10% under any other applicable code.  Members considered if a higher rating under the PEB’s clinically compatible muscle code (or under 5299-5284 to the same end) could be reasonably recommended based on the disability in evidence at separation.  Although the CI remained significantly encumbered as reflected by the NARSUM evidence, the improving clinical course corroborated the NARSUM opinion that the disability was transient.  That opinion was clinically consistent with the established diagnosis.  Members agreed that there was no route to a higher rating than the 10% adjudicated by the PEB.  

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 of the left posterior tibial tendon injury.

BOARD FINDINGS:  In the matter of the left posterior tibial tendon injury and IAW VASRD §4.73, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150715, w/atchs
Exhibit B.  Service 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

      In accordance with reference (a), I have reviewed the cases listed below 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 USMC
		-XXXXXXXXXXXXXXXXXX, former USMC
		-XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

	
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	     				  Acting