RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01587
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 E4, Fixed Wing Aircraft Mechanic, medically separated for “sinus tarsi syndrome, left greater than right” with a disability rating of 10%.  

CI CONTENTION:  She should have requested a reconsideration of her disability rating before separation.  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 - 20041001	VARD - 20050128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sinus Tarsi Syndrome, Left Greater Than Right	5299-8725	10%	Residuals, Sinus Tarsi Syndrome, Right Foot	5271-8725	10%	STR	
			Residuals, Sinus Tarsi Syndrome, Left Foot	5271-8725	10%	STR	
Posterior Tibial Tendonitis Left Foot…	Cat II	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Sinus Tarsi Syndrome, Left Greater Than Right.  The PEB combined the left and right sinus tarsi syndromes as a single unfitting condition analogously coded 5299-8725 (ankle limited motion and posterior tibial nerve neuralgia) and rated 10%.  The 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 panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of 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 sinus tarsi syndrome conditions are presented 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’s bilateral foot condition began in August 2002, exacerbated by increased impact activity.  She underwent left foot surgery in August 2003 for sinus tarsi evacuation and again in April 2004 for calcaneal osteotomy and navicular cuneiform fusion.  X-rays showed decreased joint space in the lateral gutter of both ankles, with the left worse than the right, and significant debris within the sinus tarsi on the left foot.  

The 9 June 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of continued bilateral foot pain.  Physical examination showed the CI had pain of the left sinus tarsi joint, the left anterior talofibular ligament, left navicular cuneiform joint, and left calcaneofibular ligament.  Left foot anterior drawer test for instability was negative.  On the right foot, the CI had pain of the sinus tarsi, gastrosoleal equinus, and the anterior talofibular ligament.  During the 7 July 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported left and right foot pain.  Physical examination revealed left foot decreased range of motion (ROM) with tenderness.  

At the 11 August 2004 physical therapy examination, 4 months prior to separation, the CI reported decreased strength and ROM with 6/10 pain.  Physical examination showed the left ankle ROM dorsiflexion as 0 degrees (normal 20) and plantar flexion as 35 degrees (normal 45) measured with a straight leg.  For the right ankle, dorsiflexion was listed as 15 degrees and plantar flexion as 65 degrees.  With a flexed knee, left dorsiflexion was 5 degrees and plantar flexion 45 degrees, and on the right dorsiflexion was 15 degrees and plantar flexion 60 degrees.  

The 4 October 2004 physical therapy examination, 2 months prior to separation, reported pain with prolonged standing or walking with pain rated 4/10.  Physical examination showed the left ankle ROM dorsiflexion as 5 degrees and plantar flexion as 50 degrees measured with a straight leg.  With a flexed knee, left dorsiflexion was 15 degrees and plantar flexion 50 degrees.  There was positive tenderness.  No examination of the right ankle was noted.  

At the 8 August 2005 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported pain in both feet, left greater than right, with walking.  Physical examination showed motion of the foot and ankle was normal and equal.  Dorsiflexion was 10 degrees and plantar flexion of 50 degrees with painful motion noted as mild on the right and moderate on the left.  There was no differentiation regarding measurements of the left versus right foot.  

Panel members agreed that the evidence reasonably justified that the functional limitations of both the left and right sinus tarsi syndromes contributed to the CI’s inability to perform her military duties, and accordingly a separate disability rating is recommended for each.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral sinus tarsi syndrome 10%, coded 5299-8725 as indicated above.  The Navy PEB also listed posterior tibial tendonitis of the left foot as a Category II condition (a condition that contributes to the unfitting Cat I sinus tarsi syndrome, left greater than right, but was not separately unfitting).  The VA rated residuals, sinus tarsi syndrome, separately for each foot at 10%, with each coded 5271-8725 (limited motion of the ankle – posterior tibial nerve neuralgia), based initially on the STR and confirmed after the C&P examination, citing “incomplete paralysis of foot movement which is moderate or mild” as the justification for rating each foot.  

The panel agreed that the MEB physical therapy examinations were consistent with the “moderate” limitation of motion required for the 10% rating for each ankle sinus tarsi syndrome coded 5271 (ankle limited motion).  The preponderance of evidence did not indicate an abnormal gait which caused functional loss that would impact functioning in the average civil occupation.  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 recommends a disability rating of 10% for the left ankle sinus tarsi syndrome and 10% for the right ankle sinus tarsi syndrome, both coded 5271.  

BOARD FINDINGS:  In the matter of the left ankle sinus tarsi syndrome, the panel recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  In the matter of the right ankle sinus tarsi syndrome, the panel recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Ankle Sinus Tarsi Syndrome 	5271	10%	
Right Ankle Sinus Tarsi Syndrome	5271	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161024, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:       (a) DoDI 6040.44
	(b) PDBR ltr dtd 12 Jun 18 ICO XXXXXXXXXXXXXXXXXX	
             (c) PDBR ltr dtd 05 Jul 18 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 11 Jun 18 ICO XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 05 Jul 18 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 05 Jul 18 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 05 Jul 18 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.  

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.   

     f. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.
 
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

                                  XXXXXXXXXXXXXXXXXX
                                  Assistant General Counsel
                                  (Manpower and Reserve Affairs)