RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03364 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20061031

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Vehicle Operator, medically separated for “sinus tarsi syndrome” with a disability rating of 20%.

CI CONTENTION: “I’m still suffering from ankle pain.” He 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 - 20060918	VARD - 20070206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sinus Tarsi Syndrome	5299-5284	20%	
Status Post Right Fibula Fracture	

5271	

10%	

20060519	
History of Spiral Fracture Right Fibula	

Cat II					
Peroneal/Posterior Tibial Tendonitis, Bilateral Ankles						
Plantar Fasciitis, Bilaterally		Bilateral Plantar Fasciitis	5299-5278	NSC		
Severe Pes Planus, Bilaterally		Bilateral Pes Planus	5276	NSC		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Sinus Tarsi Syndrome. According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured his right ankle after falling in July 2002 and was treated with a cast. Right ankle X-rays on 5 April 2004 were unremarkable, and on September 2004 he was diagnosed with tendonitis and right ankle    pain, which was treated with a nonsteroidal anti-inflammatory

drug. He was later given a steroid/anesthetic injection for right peroneal tendonitis and also diagnosed with pes planus. On 22 December 2004, an MRI showed no significant abnormalities.

At a podiatry consultation on 18 January 2005, the CI reported no relief from the injection and physical therapy (PT). On examination, there was no edema, erythema, ecchymosis, or lesions noted. A planus foot type was noted, with significant tenderness at the sinus tarsi of the right anterolateral ankle region as well as the peroneal tendons. There was mild discomfort with inversion, eversion, dorsiflexion and plantar flexion. The provider noted a normal MRI, and assessed right ankle sinus tarsi syndrome with peroneal tendonitis posterior and inferior to the fibula, and severe pes planus. The sinus tarsi was injected with a steroid/anesthetic combination and over-the-counter orthotics were dispensed.

At a 22 March 2005 podiatry visit, the CI indicated that injections, orthotics, and a controlled ankle movement walker did not help ameliorate his pain. The physical examination was unchanged from his prior visit, and a PEB versus surgery was discussed. At a podiatry follow-up on 30 August 2005, there was tenderness of the sinus tarsi, right greater than left, and severe pes planus with no swelling, erythema, or abnormal warmth of the foot. Ankle strength during dorsiflexion, plantar flexion, inversion, and eversion strength was normal, but the CI had an abnormal abducted stance and gait. At an orthopedic clinic visit on 30 November 2005, results of right ankle X-rays from 6 October 2005 were negative, and while the 22 December 2004 MRI showed a probable foreign body in the plantar subcutaneous soft tissues of the (right) foot just superficial to the calcaneus, there was no evidence of significant ligamentous, tendinous pathology, or osteochondral defect. The examiner’s assessment was peroneal tendonitis and he recommended PT.  Despite conservative treatment, the CI continued to have pain.

The 7 March 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of significant foot and ankle swelling and chronic arch pain, and as well as lateral ankle pain not responsive to Tylenol (pain reliever) or custom functional orthoses. Physical examination showed mild lateral ankle edema, particularly over the peroneal tendons and mid foot plantar area. There was also significant tenderness at the sinus tarsi of both ankles as well as on the plantar medial band of the fascia bilaterally. Muscular strength with plantar flexion, dorsiflexion, and inversion was normal, but with discomfort during eversion, and neurovascular findings were intact. Range of motion (ROM) was somewhat limited at the right ankle joint and bilateral subtalar joints, with mild peroneal tendon splinting and rear foot eversion in stance as well as gait.   There also was a significant collapse of the mid tarsal joint bilaterally in gait.  During the   8 May 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months before separation, the CI reported severe ankle pain and was diagnosed with severe pes planus, plantar fasciitis, sinus tarsi syndrome, and peroneal and posterior tibial tendonitis. Physical examination revealed right ankle tenderness and edema, but no erythema of the lateral malleolus. There was 4/5 strength with plantar/dorsiflexion, positive numbness on the lateral heel and lateral malleolus, and moderate pes planus.

At the 19 May 2006 VA Compensation and Pension (C&P) examination, 5 months prior to separation, the CI reported that he was diagnosed with sinus tarsi syndrome on the right and given a brace. He continued to experience right ankle pain brought on by physical activities and improved with analgesic medication. Physical examination showed an antalgic gait favoring the right due to pain, but no signs of abnormal weight bearing. The examiner documented limited and painful motion and weakness, but no redness, heat, swelling, effusion, drainage, abnormal motion, or instability. Active dorsiflexion was to 10 degrees (normal 20), and plantar flexion to 25 degrees (normal 45), with pain. Although bilateral Achilles tendon alignment was good with no plantar fasciae tenderness, there were mild flat feet deformities, and manipulation produced pain in the right foot, but not the left. Orthotics were prescribed to relieve the symptoms. At a VA new patient ambulatory care visit on 28 February 2007, 4 months after separation, the CI

reported taking Tylenol #3 (narcotic/pain reliever) for the right ankle pain. Physical examination of the extremities indicated normal ROM and pedal pulses with no effusion or edema.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the sinus tarsi syndrome 20%, analogously coded 5299-5284 (foot injuries, other), and listed “history of a spiral fracture of the right fibula, peroneal as well as posterior tibial tendonitis of the bilateral ankles, plantar fasciitis bilaterally, and severe pes planus bilaterally” as Category II conditions (related to and contribute to the primary unfitting condition). The VA rated the status post right fibula fracture 10%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing moderate, limited ankle motion.

The panel’s first charge for the Category II conditions was to assess whether any of them could be reasonably justified as separately unfitting for rating consideration. The threshold for such determinations is reasonably unfitting and remains adherent to the DoDI 6040.44 “fair and equitable” standard. Panel member agreed that the conditions were intrinsic to the rated condition and separate ratings could not be supported without pyramiding (VASRD §4.14); thus, they are appropriately subsumed in the same rating.

The panel noted that the PEB used an analogous code 5299-5284 to include the right tarsal tunnel syndrome as well as the right foot/ankle Category II conditions, and assigned a 20% rating consistent with a moderately severe disability. The panel discussed whether the condition warranted a 30% rating for a severe disability, however, by the time of the VA C&P examination, there were mild flat feet deformities, no evidence of plantar fasciae pain, and painful motion with moderate limited motion of the ankle. Therefore, proximate to separation and at a post- separation VA examination, there was insufficient evidence to support a rating for a severe right foot disability. 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 sinus tarsi syndrome.

BOARD FINDINGS: In the matter of the sinus tarsi syndrome and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended history of spiral fracture right fibula, bilateral peroneal and posterior tibial tendonitis, plantar fasciitis, and severe pes planus, the panel recommends no change from the PEB determinations. 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:

DEPARTMENT OF THE NAVi
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 

IN   REPLY  REFER  TO,
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 14 May 19

I. Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

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