RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02391
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated for “chronic left Achilles tendonitis…” with a disability rating of 10%.

CI CONTENTION:  “I believe my condition was worse than what they discharged me for.”  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 - 20080922	VARD - 20081222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Achilles Tendonitis	5024	10%	Left Ankle Joint Effusion and Achilles Tendonitis	5024	0%	20080812	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Achilles Tendonitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s Achilles condition began in August 2007 after a ruck march. He rolled his ankle at the half way point but continued to march.  After two weeks he had more difficulties with his foot and ankle, went to the aid station and was given a profile and medications.  Physical therapy and casting did not help.  Nuclear imaging showed bilateral minimal stress reaction in the tibial tuberosities and irritation of the left Achilles tendon.   

The 2 September 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of left foot pain at the Achilles tendon insertion.  The CI reported pain was worsened by running, walking greater than 1/4 of a mile, jumping, standing greater than 10 minutes and driving a manual vehicle.  Rest and ice seemed to be the only things that helped.  He reported pain was constant with anti-inflammatory medications not helpful.  He was unable to do the fitness test run, sit-ups or push-ups or the alternative walk, swim or bike.  He could not perform any impact activities or march.  Physical examination showed the range of motion (ROM) of the left foot was dorsiflexion 0 degrees (normal 20) and plantar flexion 30 degrees (normal 45).  There was no muscle spasms, atrophy, swelling or scarring.  There was tenderness in the insertion of the tendon on the left.  

At the 12 August 2008 VA Compensation and Pension (C&P) evaluation, 4 months before separation, the CI reported pain, swelling, decreased range of motion relieved by rest, ice and heat.  Physical examination showed a normal gait with no ambulatory aids, normal heel to walking, and both ankles had muscle strength 5/5 and ROM dorsiflexion of 20 degrees and plantarflexion 45 degrees with no pain on motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left tendonitis Achilles condition 10%, coded 5024 (tenosynovitis), citing 0 degrees of dorsiflexion and 30 degrees of plantar flexion, rated as moderate limitation of ankle movement.  The rating also included consideration of functional loss IAW VASRD 4.10, 4.40, 4.45 and 4.59.  The VA rated the Achilles condition 0%, coded 5024 (tenosynovitis), based on the C&P examination 4 months before separation, citing no limited motion and no tenderness to palpation.  The panel agreed that the ROM examinations proximate to separation detailed above were consistent with a moderate limitation of motion.  Because there was no ankylosis, nonunion or mal union, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 10% rating 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 for the chronic left Achilles tendonitis condition.  

BOARD FINDINGS:  In the matter of the chronic left Achilles tendonitis condition and IAW VASRD §4.71a, the panel 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 20150921, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	
AR20170012625, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.
 
A copy of this decision has been provided to the counsel you listed on your application, Illinois XXXXXXXXXXXXXXXXXXX.

Sincerely,					      
						      					
Enclosure