RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-06124
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060629

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “left posterior tibial neuropathy” with a disability rating of 20%.

CI CONTENTION: In addition to the left lower extremity (LLE) condition, the CI 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 - 20060330	VARD - 20070509	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Posterior Tibial Neuropathy	8525	20%	Left Posterior Tibial Neuropathy	8599-8525	20%	STR	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Left Posterior Tibial Neuropathy. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI fractured his left ankle in March 2005 after a fall off a wall and onto some stairs during combat. He underwent surgical repair of his ankle and was diagnosed with posterior tibial nerve injury at the time. Post-surgery radiographs in August 2005 revealed persistent anterior fibular deformity, and mild degenerative changes in the tibiotalar joint. Electrodiagnostic studies in September 2005 showed severe distal posterior tibial neuropathy.

The 31 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, revealed left ankle dorsiflexion of 0 degrees (normal 20), plantar flexion of 40 degrees (normal 45), inversion of 30 degrees and eversion of 15 degrees. There was tenderness and pain on motion of the foot and ankle. Toes on the left foot demonstrated a flexion contracture with all five toes being semi-rigid.  Gait was antalgic.

During the 17 March 2006 MEB NARSUM examination, 3 months prior to separation, the CI complained of left ankle pain and persistent clawing of all toes. He had constant pain in his left foot and ankle that was worse with prolonged standing, sitting or boot wear. The CI was unable to run, walk greater than a quarter mile or walk in bare feet without pain. Physical examination showed well-healed incisions about the left ankle, and mild chronic edema of the left compared to the right ankle. There was tenderness over the anterior aspect of the fibula and dorsum of foot. There was claw toe deformity of the first through fifth toes with stiffness, but this was reducible. The range of motion (ROM) study showed left ankle dorsiflexion of 5 degrees compared to 10 degrees on the right, and plantar flexion of 40 degrees on the left and 55 degrees on the right. Muscle strength was slightly reduced (4/5) in the tibialis anterior and posterior muscles and normal in the extensor halluces longus and peroneal muscles.

On 13 April 2006, the CI underwent left fibular ossicle resection, percutaneous flexor tenotomies of great through small toes to correct left claw foot. During the 12 July 2006 consultation examination, 3 months after surgery and 2 weeks after separation, the CI reported that he was having problems with ambulation secondary to the peripheral neuropathy. The plantar aspect of the left foot was extremely hypersensitive. Physical examination showed decreased strength to all muscle compartments of the LLE. There was tenderness with motion of the ankle joint and with ROM of the foot. There was significant loss of sensation to the dorsal and plantar aspect of the foot. Vascular examination of the left foot was normal and there was no swelling or edema in either foot. The 2-week follow-up visit noted a 30% improvement in pain symptoms after medication was implemented. The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the LLE neuropathy 20%, coded 8525 (posterior tibial nerve-paralysis of), citing severe incomplete paralysis. The VA also rated the LLE neuropathy 20%, coded analogously to 8525, based on the STR.

Panel members agreed a 20% rating and no higher was justified for severe incomplete paralysis of the LLE. The higher rating of 30% requires evidence of complete paralysis of all muscles of the sole of the foot with frequent pain, inability to flex toes and impaired plantar flexion. The July 2006 consultation, indicated slight reduction in muscle strength, but a general ability to move all muscles. Plantar flexion was not significantly reduced compared to the right. There were no additional VASRD codes that would support a higher rating. 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 LLE neuropathy.

BOARD FINDINGS: In the matter of the LLE neuropathy and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. 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.

	PD-2017-06124

XXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXX

	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.

		PD-2017-06124