RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01593
BRANCH OF SERVICE:  navy	SEPARATION DATE:  20050213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Advance Network Analyst, medically separated for “left peroneal tendinitis” with a disability rating of 10%.  

CI CONTENTION:  His rating should be higher.  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 -20041021	VARD - 20050401	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Peroneal Tendinitis	5299-5024	10%	Pes Planus	5276	0%	20050201	
Possible Reflex Sympathetic Dystrophy	Cat II	Residuals, Left Ankle Fracture	5099-5019	10%	20050201	
Closed Fractured Left Lateral Malleolus	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Peroneal Tendinitis.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI fractured his left ankle (lateral malleolar area) in January 2004 when he stepped into a hole sustaining a twisting injury.  His condition did not require surgery and he was treated conservatively.  The left ankle fracture healed but he had residual ankle pain.  In May 2004, 5 months after the injury, the CI developed left peroneal tendinitis and symptoms suggestive of left lower extremity reflex sympathetic dystrophy.  

The 8 June 2004 MEB NARSUM examination, 8 months prior to separation, noted complaints of left foot pain during activity that was worse after rest or rising in the morning and was unpredictable.  Associated symptoms include instability, tingling, swelling, and limping.  His worst pain was rated 3/10.  The examiner noted radiographs taken of the left ankle 2 days prior to the NARSUM showed satisfactory alignment and good healing.  During the August 2004 MEB examination (recorded on DD Forms 2807-1 and 2808) 6 months prior to separation, the CI reported pain in his left foot and that he walked with a limp.  Physical examination showed a normal arch, left ankle with limited range of motion (ROM), limited strength, and tenderness.  Instability was not recorded.

At the 1 February 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported he had functional impairment with prolonged walking, running, standing, or stair climbing.  He had never been ordered to bedrest for his condition, although he had lost 2-3 days per week from work.  He was working full-time.  Physical examination of the lower extremities showed no edema and normal gait and posture.  There were no signs of calluses or any unusual shoe wear pattern, and the CI used no assistive device for ambulation and no corrective shoes or orthotics.  Left ankle exam showed no evidence of inflammation.  ROM of right and left ankles demonstrated dorsiflexion of 20 degrees and plantar flexion of 45 degrees.  Painful motion was absent.  There was weakness and lack of endurance during left knee motion, accompanied by pain.  Ankle instability was not recorded.  Examination of the left foot showed absence of painful motion, edema, weakness, or atrophy, and blood circulation was intact.  There was tenderness, but lower extremities showed normal motor function and sensory function.  The examiner opined that the peroneal tendon and nerve damage had improved.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of left peroneal tendinitis at 10%, coded analogously to 5024 (tenosynovitis), based on limitation of motion.  The PEB also listed “possible reflex sympathetic dystrophy” and “closed fracture left lateral malleolus” as related Category II conditions (contributed to the primary unfitting condition but were not separately unfitting or ratable).  Panel members agreed the impairment from these was properly subsumed under the overall rating for the “left peroneal tendinitis” IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the condition of residuals, left ankle fracture (also claimed as reflex sympathetic dystrophy and nerve damage) 10%, coded analogously to 5019 (bursitis), based on the C&P examination, citing functional loss due to pain.  

The panel considered codes 5271 (ankle limitation of motion) and 5284 (foot injuries, other); however, neither code led to the higher rating of 20% since there was no limitation of motion (LOM) of the ankle at the C&P examination 2 months before separation, and the LOM noted during the MEB examination did not rise to the level of “marked” LOM.  Given that the CI’s condition did not require bedrest, the use of assistive devices, orthotics, and there was no marked LOM, the evidence to warrant a rating for moderately severe condition under code 5284 was absent.  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 left peroneal tendinitis condition.  

BOARD FINDINGS:  In the matter of the left peroneal tendinitis 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 20160916, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

	XXXXXXXXXXXXXXXXXX
	Acting