RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01396
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Medical Specialist, medically separated for “status post right posterior tibial tendon reconstruction” with a disability rating of 20%.   

CI CONTENTION:  “A lot of things weren’t considered.”  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 it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040412	VARD - 20041130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Right Posterior Tibial Tendon Reconstruction	5099-5003	20%	Status Post Right Posterior Tibial Tendon Reconstruction	5271	20%	20040921	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Status Post Right Posterior Tibial Tendon Reconstruction.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent posterior tibialis tendon reconstruction using the flexor hallucis longus tendon with a medial calcaneus sliding osteotomy and a gastrocnemius recession on 11 June 2003, approximately 12 months prior to separation, to correct right rigid flat foot and Achilles tendon tightness.  

During the 9 December 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported recurrent foot and ankle pain, with swelling of the ankle and decreased range of motion (ROM).  Physical examination showed decreased right ankle ROM and a scar on the right calf and ankle.  Symptomatic pes planus of moderate severity was also documented. 

The 3 February 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant severe right foot pain.  The CI reported he used a cane all the time.  Physical examination of the right ankle and foot showed a well-healed surgical scar with tenderness about the distal posterior tibial tendon.  ROM testing recorded 5 degrees of dorsiflexion (normal 20) and 30 degrees of plantar flexion (normal 45).  The CI was unable to perform a single stance heel rise.  Radiographs showed stable hardware.

At the 21 September 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported numbness, soreness, and stiffness in his ankle, calf, and heel.  His symptoms were constant and he was unable to run.  The CI did not require the use of assistive device for ambulation.  Physical examination showed a normal gait with no evidence of abnormal weight bearing.  There was swelling of the right ankle joint, but otherwise normal appearance.  ROM testing recorded 10 degrees of dorsiflexion with pain, and 20 degrees of plantar flexion with pain.  ROM was not additionally limited by fatigue, weakness, lack of endurance or incoordination.  The neurological examination of the lower extremities showed normal motor strength, sensation and reflexes.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right lower leg condition 20%, coded 5099-5003 (analogous to degenerative arthritis), citing marked and constant pain IAW the US Army Physical Disability Agency pain policy.  The VA also rated the right lower leg condition 20%, coded 5271 (limited motion of the ankle), based on the C&P examination 4 months after separation, citing marked limitation of motion.

The panel agreed a 20% rating was justified under code 5271, for marked limitation of motion.  This is the highest achievable rating under this code.  The panel noted there were no additional codes that would allow for a higher rating, with the exception of code 5270 (ankle, ankylosis of) which was not applicable in this case since ankylosis was not identified in the clinical data.  The panel also considered foot codes 5276 (flat foot), 5283 (tarsal, or metatarsal bones, malunion of, or non-union of) and 5284 (foot injuries, other); however, the panel was unable to justify a rating under any of these codes.  There were no additional codes to consider.  The panel considered changing the code to 5271 since that code better reflected the CI’s disability, but there was no rating advantage to the code change.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right lower leg condition

BOARD FINDINGS:  In the matter of the right lower leg 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.  Therefore the panel recommends 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 20161012, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001576, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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