RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-01516
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20041215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Ground Communications Organizational Repairer, medically separated for “chronic Achilles tendinitis bilaterally” with a disability rating of 10%.

CI CONTENTION:  “Achilles tendinitis and bursitis condition is worsening and affecting job performance and ability to do certain jobs.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20041008	VARD - 20050421	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Achilles Tendinitis Bilaterally	5024-5003	10%	Left Achilles Tendonitis	5024	0%	STR	
			Right Achilles Tendonitis	5024	NSC		
Retrocalcaneal Bursitis Bilaterally	Cat II	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Chronic Bilateral Achilles Tendinitis (AT).  The PEB combined the left and right AT conditions under a single disability rating, dual coded 5024-5003 (tenosynovitis-degenerative arthritis).  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The PEB also adjudicated bilateral retrocalcaneal bursitis as a related Category II condition.  In this case the unfitting Category I and Category II conditions refer to the same disability and cannot be separated for individual fitness determinations or ratings.  The panel noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the left and right AT conditions are presented below, with attendant recommendations regarding separate unfitness, and separate rating if indicated. 

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI first reported left ankle pain during basic training at a primary care visit on 5 December 2002.  Physical examination showed mild edema of the left Achilles tendon and he was diagnosed with AT.  At a 10 March 2003 orthopedic visit, physical examination showed tenderness of the left AT insertion and the diagnosis was retrocalcaneal bursitis.  The CI was subsequently placed on 8 months of limited duty.  Left ankle and heel imaging showed a calcaneal bone spur and no other abnormalities.  On 8 September 2003, a primary care provider summarized his history as bilateral AT and left retrocalcaneal bursitis.

During the 17 October 2003 VA Compensation and Pension (C&P) examination, 14 months before separation, the CI reported left AT pain, and physical examination showed a normal gait.  There was swelling and tenderness of the distal portion of the Achilles tendon and of the calcaneal bursa below the tendon.  Left ankle range of motion was dorsiflexion of 20 degrees (normal) and plantar flexion of 35 degrees (normal 45), with pain.  Examination of all other joints was normal.  On 14 June 2004, a podiatrist noted the CI was awaiting a MEB for AT and documented left posterior heel tenderness greater than the right.

The 15 June 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of bilateral heel pain, left greater than right, especially while wearing boots or shoes.  Physical examination showed mild edema of the posterior left heel at the AT insertion, and tenderness of both ATs with dorsiflexion, left more than right.  During the 27 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months before separation, the provider documented “mild” left AT insertion tenderness and “min” right AT tenderness.

The panel first considered whether both the left and right AT conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The CI only sought treatment for left ankle pain and it was the only joint imaged and subject to limited duty restrictions as well as physical therapy.  A single primary care evaluation in September 2003 noted bilateral AT, but the CI never complained of right ankle pain or sought treatment for it.  The Joint Disability Evaluation Tracking System notes referred to bilateral heel pain, but only documented objective left heel swelling.  Thus, members determined the left AT was reasonably considered separately unfitting, but not the right AT.

The panel directed attention to its rating recommendation for the left AT condition based on the above evidence.  The PEB rated bilateral AT 10%, analogously coded 5024-5003 as mentioned above.  The VA rated the left AT condition 0%, coded 5024, based on the C&P examination, citing a non-compensable evaluation in the absence of painful or limited motion.  Members agreed there was insufficient limitation of motion for a rating under code 5271 (limitation of ankle motion).  However, there was evidence of painful motion with functional loss supporting a 10% rating, coded analogously to 5271 IAW §4.59, §4.40 and §4.45, as recorded on the MEB NARSUM and VA examinations proximate to separation.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all 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 bilateral AT condition.

BOARD FINDINGS:  In the matter of the chronic bilateral AT 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.  Therefore, the panel recommends 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 20161003, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- 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
	     				                        Assistant General Counsel
						        (Manpower and Reserve Affairs)