RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03276 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060815

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aviation Supply Specialist, medically separated for “status post (S/P) talocalcaneal fusion for fibrous tarsal coalition” with a disability rating of 10%.

CI CONTENTION: “…rating does not include my rating for my back or hip problem…pain on a daily basis with limited range of motion (ROM)…limp that has caused continued hip and back problems….” The hip and back problems were 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 - 20060619	VARD - 20070807	
Condition	Code	Rating	Condition	Code	Rating	Exam	

S/P Talocalcaneal Fusion for Fibrous Tarsal Coalition	

5272	

20%
EPTS -10%	
Residual, Subtalar Fusion, Left Ankle	
5271	
20%	
20070317	
			Scars, Left Ankle Associated with Residuals, Subtalar Fusion, Left Ankle	7805	0%	20070317	
Left Foot Hardware Removal	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

S/P Talocalcaneal Fusion. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s foot condition began in mid-2004. The CI’s 27 February 2003 military enlistment physical noted mild asymptomatic pes planus (flatfoot). In 2004, the CI initially was treated for plantar fasciitis. Subsequent podiatry examinations diagnosed a tarsal coalition (abnormal fibrous/bony connection between bones of the foot) of the left foot and he underwent two left foot surgeries - subtalar joint fusion (arthrodesis) in April 2005 and hardware removal in February 2006. Post-operative X-rays showed satisfactory alignment and eventual solid fusion of the subtalar joint. No significant improvement followed the surgeries and physical therapy.

At the 17 May 2006 MEB NARSUM examination, 3 months prior to separation, physical examination showed the left heel in relative valgus position (angled outward) to the forefoot and tenderness of the left lateral heel. The left foot/ankle had only a slightly limited plantar flexion which slowly improved with physical therapy. There was diffuse discoloration of the lateral heel consisting of hyperpigmented spots, but no sensory deficits were noted. The CI circumducted his left foot when he planted the foot in a straight line of forward progression (abnormal gait) with pain. At the 19 May 2006 physical therapy examination, 3 months prior to separation, the CI reported no relief of symptoms since the surgery except for the resolution of the pain on the dorsum of the foot. He reported numbness/tingling and hypersensitivity over the medial dorsal and plantar aspects of the left foot. Physical examination showed a normal gait in tennis shoes. Left foot/ankle dorsiflexion was “equal bilaterally” and plantar flexion was 50 degrees (normal 45). Strength seated was 5/5, but the CI was unable to complete a single leg calf raise on the left. Poor balance was noted on the left side with decreased left ankle strength and range of motion (ROM).

At the 17 March 2007 Compensation and Pension (C&P) feet examination, 7 months after separation, the CI reported daily intermittent left foot pain, aggravated by walking and standing. He reported use of shoe inserts and on some days, a cane. Physical examination showed a limp due to left foot and ankle pain. The CI was able to rise up on heels and toes. There was pes planus of the left foot with normal alignment of the Achilles tendon. There was tenderness of the left hindfoot. There was no forefoot or mid-foot malalignment. There was no other foot deformity. There was pain with walking and standing due to the fusion.

At the 9 June 2007 VA Compensation and Pension (C&P) ankle examination, 10 months after separation, the CI reported left ankle pain, stiffness, fatigability, and lack of endurance aggravated by activity. Physical examination showed dorsiflexion at 0 degrees (normal 20) and plantar flexion of 30 degrees, with pain at the end of ROM. A limp was noted due to left foot and ankle pain. No fatigue, weakness, lack of endurance, incoordination or instability was noted. Functional limitations were the same as noted above due to pain. Left ankle X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the s/p talocalcaneal fusion condition as existing prior to service (EPTS) and service aggravated, rated 20%, coded 5272 (ankylosis of subastragalar or tarsal joint) with a 10% EPTS deduction, for an overall rating of 10%. The PEB also listed “hardware removal left foot” as a related Category II condition (contributed to the primary unfitting condition but was not separately ratable). The impairment from this condition was properly subsumed under the overall rating for the s/p talocalcaneal fusion for fibrous tarsal coalition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated “residuals, subtalar fusion, left ankle” 20%, analogously coded 5271 (ankle, limited motion), based on the C&P examination, citing marked limited motion of the ankle.

The panel agreed that the ROM examinations proximate to separation were consistent with the “marked” limitation of motion required for the maximum 20% rating under this code, and were also supported by the presence of an abnormal gait. The panel did not find evidence to determine the degree of disability that was present at the time of entrance into the service. Therefore, the panel concurs that no deduction from the PEB’s 20% rating is recommended. Although the panel’s rating recommendation is based on a different code than the PEB, there is no benefit to the CI to recommend a coding change. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the s/p talocalcaneal fusion condition, coded 5272.

BOARD FINDINGS: In the matter of the status post talocalcaneal fusion for fibrous tarsal coalition condition, the panel recommends a disability rating of 20%, coded 5272 IAW VASRD §4.71. 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	
Status Post Talocalcaneal Fusion for Fibrous Tarsal Coalition	5272	20%	

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB:003 12 Oct 20

From: To:

Subj: Ref:

Director, Secretary of the Navy Council of Review Boards 
PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr of 21 May 19
(b)	

1.	Pursuant to reference {a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.
2.	On s October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEE) from 10% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the office of the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.