RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00800
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040507

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Food Service Specialist, medically separated for “chronic left heel pain” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20040305	VARD - 20041102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Heel Pain	5099-5003	10%	Chronic Left Heel Pain, Status Post Achilles Tendon Repair	5284-7804	10%	20040803	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Heel Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left heel condition began in May 2003 after an Achilles tendon rupture.  The heel pain persisted despite surgical repair, and September 2003 radiographic evaluation (X-Rays and MRI) documented post-traumatic Achilles tendon thickening and calcifications as well as degenerative ankle changes.

The 30 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, showed an antalgic gait and tenderness along the left heel and surgical scar. On the same day at the MEB NARSUM examination, the CI reported weakness, and persistent pain that worsened with walking and cold weather.  Physical examination showed tenderness over the Achilles tendon, and a slight antalgic gait with inability to toe or heel walk secondary to pain and weakness.  Both dorsiflexion and plantar flexion were to 10 degrees (normal 20 and 45 degrees respectively).  

At the 3 August 2004 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported daily pain that “should not interfere with the job he [was] seeking,” and denied use of assistive devices.  Physical examination showed a normal gait without weakness, sensory loss, or deformity.  Dorsiflexion and plantar flexion were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left heel condition 10%, coded 5099-5003 (arthritis, degenerative), citing slight pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the left heel condition 10%, analogously coded 5284-7804 (foot injuries, other; scar, unstable or painful), based on the VA C&P evaluation 3 months after separation, citing a painful surgical scar.  There was documentation of painful motion causing functional loss which supported the 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The panel considered the evidence for a higher rating.   There was no record of a “marked” deformity of the os calcis for a higher rating under 5273.  Despite documentation of an antalgic gait prior to separation, the injury did not approach the level of “moderately severe” for a higher rating under 5284.  The panel considered whether the limitation of motion was “moderate” or “marked” for a higher rating under diagnostic code 5271 (ankle, limited motion), and agreed it did not approach the “marked” level  in support of a higher 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 left heel condition.   

BOARD FINDINGS:  In the matter of the chronic left heel pain condition 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 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 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170017988, 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.

Sincerely,					      
						      					
Enclosure