SAF/MRBD (PDBR)
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

MEMORANDUM FOR THE DIRECTOR, AIR FORCE REVIEW BOARDS AGENCY

SUBJECT:  Physical Disability Board of Review Recommendation on
        Case Number PD-2019-00046

	In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual from the United States Air Force.  After carefully reviewing the application and medical separation case file, the PDBR recommended no re-characterization of the separation or modification of the disability rating previously assigned.  I recommend you accept this proposed decision. 

The covered individual was an active duty E5, Emergency Management Journeyman, medically separated with a disability rating of 10% for “chronic Achilles tendonitis status post debridement and repair with ostectomy/resection Haglund deformity which existed prior to service with service aggravation.”  The PEB coded the condition 5311 (VASRD §4.73 muscle disability code for Group XI, dorsal foot), citing the applicable “moderate” criterion.  The VA rated the condition 10%, coded 5299-5271 (analogous to ankle, limited motion), based on the Compensation and Pension examination and citing the applicable “moderate” criterion of code 5271 (highest rating is 20% for “marked” limitation of motion).  The VA conferred a separate rating of 10% for pes planus, coded 5284 (foot, other injuries), and cited findings that overlapped with the ankle rating (dubiously compliant with the VASRD §4.14 prohibition of pyramiding).  There were no distinct ratable criteria in evidence that could be separately allocated for the ankle and foot disability without pyramiding.  Furthermore, the foot diagnoses (hallux valgus, pes planus, and intermittent plantar fasciitis) were stable baseline conditions, unrelated to the Achilles tendonitis or surgery, and could not be reasonably justified as separately unfitting.  The PEB’s muscle disability code 5311 was a reasonable choice, and is clinically aligned with the pathology and functional impairment.  Alternate codes considered for analogous rating of functional impairment were 5299-5283 (analogous to malunion or nonunion of the tarsal or metatarsal bones) and 5284 (per VA pes planus rating), but these are rated under the identical scale as for code 5311.  The functional impairment in evidence was not reasonably characterized as more than moderate, thus no higher rating was supported under any of these codes.  The range of motion evidence did not support a higher rating under the VA code 5271.  There was no other criterion in evidence that would support favorable rating under any applicable VASRD §4.71a foot or joint code.  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 right ankle/foot condition.

	

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2019-00046.

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 appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.