RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02091
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20020731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Motor Transport Maintenance Chief, medically separated for “chronic Achilles tendinitis/bursitis,” rated 10% each, respectively, with a combined  disability rating of 20%.

CI CONTENTION:  “The heel spurs have grown back, I now have arthritis in both feet, have bone spurs in both feet.”  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 progression or complications of service-connected conditions after separation.  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 - 20020624	VARD - 20021113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Achilles Tendinitis/ Bursitis 	5299-5003	10%	Left Retrocalcaneal Spur	5015-5284	0%	20020618	
			S/P Left Heel Surgery X5 with Residuals Ankle and Heel Scar	7804	10%		
		10%	Right Retrocalcaneal Spur	5015-5284	0%		
			S/P Right Heel Spur Removal and Achilles Tendon Surgery with Residual Scar	7805	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Bilateral Achilles Tendinitis/Bursitis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered an atraumatic onset of bilateral heel and ankle pain in 1996 and was diagnosed with bilateral Achilles tendinitis.  The CI underwent a series of surgeries commencing in September 1996.  He had heel spurs removed from both feet; and, underwent three subsequent surgeries on his left foot (calcific debridement with surgical pinning, followed by two debridement surgeries), the last of which was in September 2000 (22 months before separation).  Clinical STR entries documented grossly normal range of motion (ROM) of both ankles, with painful motion specified by some examiners, and no entries to the contrary.  There was no STR documentation of any additional VASRD-ratable findings or alternate diagnosis coded in the VASRD.  Post-operative radiographic (X-rays) showed normal alignment with post-operative changes, and bilateral heel spurs.  

The 15 January 2002 NARSUM examination, 6 months prior to separation, documented nonspecific bilateral ankle and foot pain that prohibited running or prolonged weight bearing.  Physical examination recorded normal strength, bony protuberances of the heels (Haglund’s deformity), and bilateral tenderness along the Achilles tendons and posterior heels.  Although the presence of normal ankle ROM was not corroborated, painful motion with active dorsiflexion or “any tension on the Achilles” was noted.

The 18 June 2002 VA Compensation and Pension (C&P) examination, 6 weeks before separation, documented nonspecific heel pain that prohibited running and limited walking to one mile.  Physical examination recorded a normal gait, a “slightly” tender surgical scar of the left ankle, and otherwise normal findings; specifically excluding the presence of all VASRD ratable foot diagnoses.  ROM measurements showed a normal dorsiflexion of 20 degrees and a normal plantar flexion of 45 degrees, specifically excluding painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each ankle at 10%, analogously coded 5003 (arthritis, degenerative) was consistent with VASRD §4.71a criteria for the service evidence.  The VA rated each condition 0%, coded 5015-5284 (benign bone growths - foot injuries, other), citing the absence of ROM limitation or painful motion per the C&P findings.  The VA additionally rated the left foot surgical scar 10% under code 7804 (scar(s), unstable or painful) and rated the right foot surgical scar 0%, under code 7805 (scars, other).  

There was no evidence for ROM limitation or any other ratable criterion that would justify a rating higher than 10% for either foot under any other applicable code available in VASRD §4.71a.  A higher rating under code 5284 would require at least “moderately severe” disability, which members agreed was not supported by the functional evidence.  Members also agreed that extra rating under a scar code, even if conceded as unfitting, would violate VASRD §4.14 (avoidance of pyramiding).

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 bilateral Achilles tendinitis/bursitis.

BOARD FINDINGS:  In the matter of the bilateral Achilles tendinitis/bursitis and IAW VASRD §4.71a, 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 20150729, w/attachments
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

      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