RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-00830
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Field Artillery Automated Tactical Data Systems Specialist, medically separated for “bilateral shin splints” and “bilateral Achilles tendonitis,” rated at 0% each, with a combined disability rating of 0%.  

CI CONTENTION:  The VA rated his conditions 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 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 - 20070123	VARD - 20070517	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Shin Splints 	5022	0%	Multiple Joint Complaints…..Bilateral Tendonitis Achilles, Bilateral Shin Splints and Bilateral Plantar Fasciitis	5024	10%	20070517	
Bilateral Achilles Tendonitis	5024	0%					
COMBINED RATING:  0%		

ANALYSIS SUMMARY:  

The PEB combined the right and left Achilles tendonitis conditions under a single disability rating, coded 5024 (tenosynovitis) rated 0%.  The PEB also combined the right and left shin splints under a single disability rating coded 5022 (periostitis) rated 0%.  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 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.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s conditions of bilateral Achilles tendonitis and bilateral shin splints began in April 2006 about one month after entering active duty.  At the 19 October 2006 primary care clinic, the CI presented for profile determinations with regard to his bilateral Achilles tendonitis and leg pain.  Physical examination showed an abnormal gait and tenderness on the tibial shafts of both legs.  However, there was normal movement and appearance of all extremities.  

The 8 December 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of persistent bilateral heel pain and shin pain.  The examiner noted a slightly antalgic gait, but there was no edema, effusion, or muscle atrophy of the bilateral lower extremities.  Tenderness was noted at the mid one-third of the tibias as well as at the insertion of the Achilles tendons.  At the 11 December 2006 physical therapy range of motion (ROM) study the CI complained of bilateral ankle, heel, and Achilles pain.  The examiner recorded a slow gait with a slightly wide base.  ROM measurements of the ankle after repetitive motion showed dorsiflexion of 5 degrees (20 normal) and plantar flexion of 40 degrees (45 normal) with pain at end range of dorsiflexion.  The bilateral knee ROM was normal and painful motion was not addressed.  

At the 3 April 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported bilateral ankle pain that traveled up to his knees.  On examination the gait and stance were within normal limits.  There was tenderness of the bilateral knees, but no instability.  ROM studies of the knees revealed 140 degrees of flexion and 0 degrees of extension (both normal) with pain recorded at 140 degrees and 0 degrees, respectively.  ROM of the bilateral ankles was 20 degrees dorsiflexion and 45 degrees plantar flexion (both normal) with pain recorded at 20 degrees and 45 degrees, respectively.  X-ray studies of the bilateral legs, ankles, and feet were normal.  

At the 9 August 2007 primary care consult, 6 months post separation, the examiner recorded the CI was in no apparent distress and had a steady gait.  Although there was pain-free limitation of ankle “flexion” noted by the examiner, there were no measurements recorded.  There was no mention of his bilateral knee conditions.  

On 5 September 2007, at the podiatry consult 7 months after separation, the CI reported bilateral heel pain.  The examiner recorded the condition was managed well in the past and there had been no treatment for the past six months.  The CI was employed as a stocker, which involved climbing and carrying items.  The examiner reported a good propulsive gait and no gross malalignment or deformity.  Limitation of bilateral ankle dorsiflexion was recorded at -6 degrees with the knee extended and 10 degrees with the knee flexed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral Achilles tendonitis condition 0%, coded 5024, and the bilateral shin splints condition 0%, coded 5022.  The VA rated multiple joint complaints 10%, coded 5024, based on the C&P examination, citing “painful or limited motion of a major joint or group of minor joints.”

The panel first considered if the right and left Achilles tendonitis conditions and the right and left leg conditions (shin splints), having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  In this case, both legs and ankles failed retention standards and both were profiled.  The bilateral Achilles tendonitis conditions were not implicated by the commander, but the bilateral shin splints were implicated.  The panel agreed that there was not a preponderance of evidence to overcome the presumption that each of the four conditions were reasonably considered unfitting.  

The panel noted pre-separation evidence of moderate bilateral ankle limitation of motion due to Achilles tendonitis which warranted a 10% rating for each ankle coded 5024-5271.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a rating of 10% for each Achilles tendonitis condition, coded 5024-5271.  

In regards to the bilateral shin splints, the panel noted that there was no evidence of painful knee motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) or X-ray evidence of involvement of 2 or more major joints or 2 or  more minor joints to warrant a rating higher than 0% under code 5022.  There likewise was no knee limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  Therefore, the panel concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB under any applicable code for either of the shin splint conditions.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bilateral shin splint condition.

BOARD FINDINGS:  In the matter of the bilateral Achilles tendonitis condition, the panel recommends a disability rating of 10% for each ankle, each coded 5024-5271, IAW VASRD §4.71a.  In the matter of the bilateral shin splint 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.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Left Achilles Tendonitis	5024-5271	10%	
Right Achilles Tendonitis	5024-5271	10%	
Bilateral Shin Splints	5022	0%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, date 20170218, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004917, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure