RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxx	CASE:  PD-2017-00416
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “chronic right tarsal tunnel syndrome” with a disability rating of 10%. 

CI CONTENTION:  “The issues were worse than what was evaluated...”  The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070305	VARD - 20040417	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Tarsal Tunnel Syndrome	8799-8725	10%	Tarsal Tunnel Syndrome with Surgical Release and Recurrent Sprains, Right Ankle	5399-5271	10%	20070323	
Elevation of Transaminase Levels	Not Unfitting	Fatty Liver	7399-7806	NSC	20070323	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Tarsal Tunnel Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right ankle surgery in August 2000 for a right posterior tibial tendon repair and a tarsal tunnel release.  In 2003 the CI underwent an MEB for complaints related to the right foot and was found fit for duty.  Post-deployment, on 10 April 2006, the CI reported the symptoms of pain and numbness of the right foot and leg were slowly returning.  X-rays of the right ankle on 4 May 2006 were normal.  An MRI of the right ankle dated 6 June 2006 showed no evidence of a mass lesion or scar impingement of the posterior tibial nerve within the tarsal tunnel status post tarsal tunnel release.  

At an orthopedic clinic visit on 7 July 2006, the CI reported pin and needles sensation over most of the bottom of his foot with radiation to the calf and knee along with throbbing and a dull, aching pain behind the ankle in an area of a throbbing vessel.  Wearing of a boot or any other shoe that touched the back of the medial ankle caused an increase in symptoms.  He also claimed occasional instability while walking and occasional popping with rolling or stretching of the ankle.  At a vascular clinic appointment on 14 July 2006, examination showed a pulsation posterior to the scar from the tarsal tunnel release on the posterior aspect of the right ankle medial malleolus.  Capillary refill was less than 2 seconds.  An ultrasound revealed no aneurysm, pseudo aneurysm, or A-V (arteriovenous) malformation.  The examiner’s assessment was a superficial vessel (posterior tibialis) of the right ankle. 

 At a vascular surgery clinic visit on 14 August 2006, the examiner reviewed the prior MRI and noted the tortuous vessel did not require any additional vascular surgery intervention, but that the CI may have had plantar fasciitis in conjunction with his ankle pain.  At an orthopedic clinic visit on 31 August 2006, there was full range of motion (ROM) of the right ankle without popping, clicking, crepitus, or reported discomfort and a palpable and visible pulsating posterior tibial artery that bulged from under the skin and appeared somewhat tortuous.  There was no palpable deformity in the ankle or mid foot and there were no surgical indications.  

During the 3 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported numbness in the right foot.  Physical examination revealed tenderness and numbness of the right ankle.  The 22 February 2007 MEB NARSUM examination, one month prior to separation, noted the complaint of right foot pain.  Physical examination showed a scar approximately 12 cm in length, which was non-tender.  The CI had mild tenderness over the right calf.  He had 2+ dorsal pedis and posterior tibial pulses.  Sensation and strength were intact.  There was a noticeable cluck with circumduction of the right ankle.  ROM measurements were 15 degrees dorsiflexion (normal 20), 53 degrees plantar flexion (normal 45), 26 degrees inversion, and 16 degrees inversion.  Motions were limited by mechanical end feel, not pain.  At an orthopedic clinic visit on 28 November 2006, gait and stance were normal, and there was no evidence of any sensory loss or peripheral neuropathy.  

At the 23 March 2007 VA Compensation and Pension (C&P) examination, 6 days after separation, the CI reported pain in the right ankle and numbness, if he had a flare.  Physical examination of the right ankle showed flexion was 8 degrees and extension was 40 degrees, both with pain.  Tinel’s sign (to determine nerve irritation) was negative and no crepitance (grinding sensation) was noted.  The examiner opined that during repetition and/or acute flares there would be  5 degrees loss of extension and 2 degrees loss of flexion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the tarsal tunnel syndrome condition 10%, analogously coded 8799-8725 (neuralgia), citing full motion, good stability and equivalent to mild partial paralysis.  The VA rated the tarsal tunnel syndrome condition 10%, analogously coded 5299-5271 (ankle, limited motion) based on the C&P examination, citing functional loss due to pain.  The panel noted that code 8725 assigns a 10% rating for both mild and moderate neuralgia equivalent to incomplete partial paralysis of the posterior tibial nerve.  There was no evidence that the neuralgia was equivalent to a severe partial paralysis of the posterior tibial nerve to warrant a 20% rating since there was no evidence of a neuropathy or radiculopathy at the orthopedic examination proximate to separation and Tinel’s sign was negative at the VA examination.  The panel noted the VA rating used code 5271; however, there was no evidence of marked limitation of the ankle to warrant a rating higher than 10%.  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 chronic right tarsal tunnel condition.  

Contended PEB Condition:  Elevation of Transaminase Levels.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic right tarsal tunnel syndrome condition and IAW VASRD §4.124a the panel recommends no change in the PEB adjudication.  In the matter of the contended elevation of transaminase levels condition, the panel agrees it cannot recommend it for additional disability rating.  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 20170211, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008814,  

Dear xxxxxxxxxxxxxx:

	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.