RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxx 	CASE:  PD-2017-04164
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Communication Cable System Apprentice, medically separated for “bilateral tarsal tunnel syndrome” with a disability rating of 0%.  

CI CONTENTION:  The VA provided a higher rating for the condition.  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 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 - 20051228	VARD - 20060306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Tarsal Tunnel Syndrome, Mild	8799-8725	0%	Tarsal Tunnel, Left Ankle	5283	10%	20060123	
			Tarsal Tunnel, Right Ankle	5283	10%	20060123	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bilateral Tarsal Tunnel Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced bilateral ankle/foot pain in July 2004 during basic training without any preceding event or specific trauma; she was diagnosed with bilateral tarsal tunnel syndrome (TTS) during a podiatry evaluation in December of 2004.  Despite physical therapy, medications and orthotics, the pain continued.  Electrodiagnostic studies performed on 10 August 2005, 6 months prior to separation, noted findings of bilateral TTS.  At the 13 December 2005 MEB NARSUM examination, 2 months prior to separation, the CI’s chief complaint was bilateral ankle pain which was “present for 24 hours a day which radiates to the distal digits and up into the legs.”  The physical examination (PE) documented only left ankle/foot findings which revealed a positive Tinel’s sign (tingling sensation when the nerve is tapped) over the left tibial nerve.  Bilateral ankle X-rays were normal.  During the 23 January 2006 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported a constant deep achy pain in both ankles which increased with running, jumping, or with prolonged standing/walking.  The PE revealed bilateral ankle tenderness with full ranges of motion (ROM) for dorsiflexion and left-sided plantar flexion and only a slight decrease in right-side plantar flexion of 41 degrees (normal 45).  There was no evidence of painful motion or abnormal weight-bearing on the plantar surface of either foot.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral TTS 0%, analogously coded 8725 (neuralgia of the posterior tibial nerve), citing no guarantee of normal functional response if surgical intervention was performed.  The VA rated the left ankle tarsal tunnel and right ankle tarsal tunnel conditions 10% each, coded 5283 (tarsal, or metatarsal bones, malunion or nonunion), based on the C&P examination, citing moderate impairment from subjective pain, EMG findings and limited motion.  The panel’s initial charge in this case was directed at determining whether the PEB’s approach of combining the bilateral tarsal tunnel conditions under a single rating was justified in lieu of separate ratings.  All panel members extensively deliberated over the question of separate findings of unfitness and ultimately agreed that despite a minimization of adverse physical symptoms seen in either foot, the sole finding of left-sided nerve irritation (positive Tinel’s sign) as well as the right-sided joint tenderness could singlehandedly manifest a degree of the CI’s physical complaints, and thus, each foot was determined to be separately unfitting and thus ratable.  Panel members further agreed that the PEB’s chosen primary code of 8725 was most appropriate for either ankle and the corresponding physical findings would support separate diagnostic ratings.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends separate disability ratings of 10% (mild) for the left ankle condition; and 0% for the right ankle condition.  

BOARD FINDINGS:  In the matter of the bilateral tarsal tunnel syndrome, the panel recommends separate disability ratings of 10% for the left ankle and 0% for the right ankle, each coded 8725 IAW VASRD §4.124a.  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	
Left Tarsal Tunnel Syndrome	8725	10%	
Right Tarsal Tunnel Syndrome	8725	0%	
COMBINED	10%	

The following documentary evidence was considered:  

SAF/MRB
XXXX XXXXXX XXXX
XXX XXX XXXXXX, XX XXXXX

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04164.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not in accordance with the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept the recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.