RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1200368
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20130806
SEPARATION DATE:  20050121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve CPL/E-4 (2171/Electro-Optical Ordinance Repairer) medically separated for chronic left heel pain, status post (s/p) posterior calcaneal decompression.  The CI injured his left foot in boot camp in October 2001.  He developed pain at the insertion of the Achilles tendon and was diagnosed with osteophytes in the Achilles tendon.  Despite surgical intervention, the condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The chronic left heel pain, s/p posterior calcaneal decompression condition was characterized as medically unacceptable and was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The PEB adjudicated chronic left heel pain, s/p posterior calcaneal decompression as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Wrist injury was not looked at as part of the med discharge/rating too low for condition/lower back pain lower back pain was not looked at because it felt like it was because of the crutches, cast, and later heel surgery.  The back injury is pending at the time.  The wrist was combat related and the heel was also combat related.  See attached documentation.  The medical discharge should have been combat related.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The ratings for the unfitting chronic left heel pain, s/p posterior calcaneal decompression condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records (BCNR).

RATING COMPARISON:

Service IPEB – Dated 20041007	VA - Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Heel Pain, Status Post Posterior Calcaneal Decompression	5024-5003	10%	Left Calcaneal Spur Excision with Achilles Tendonitis	5015-5271	10%	20041224	
			Left Foot Surgical Scar	7804	0%	20050107	
No Additional MEB/PEB Entries	Other x 6	20050107	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20050422 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.  The Board acknowledges the CI’s contention that his medical condition should have been determined to be combat related.  The Board does not have the jurisdiction to offer remedy in reference to Service decisions of this nature.  That authority resides with the BCNR.

Chronic Left Heel Pain Condition.  The CI experienced the onset of left heel pain in the area of the Achilles tendon insertion during basic training in October 2001.  Despite rest, physical therapy and casting, pain continued to interfere with running.  Radiographic imaging showed bone spur formation of the calcaneus, and calcification and partial tearing of the Achilles tendon.  Surgical excision of the bone spur on 19 December 2003 did not result in sufficient improvement to allow return to running or jumping.  On 4 August 2004 (6 months prior to separation), the narrative summary examiner reported an inability to jump, run or dismount from any object more than one foot off the ground.  Physical examination noted a normal gait.  Tenderness of the medial and lateral aspect of the heel was present.  The VA Compensation and Pension exam was performed on 24 December 2004 (a month prior to separation) but was not in evidence.  However, the VARD dated 22 April 2005 quoted the examiner’s evaluation as showing a very prominent Haglund’s deformity (a bump on the posterior calcaneus) and apparent partially ruptured Achilles tendon.  Muscle atrophy was noted on the side of the ankle, but there was no swelling or limp.  Painful motion was present.  The goniometric range-of-motion evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Ankle ROM
(Degrees)	NARSUM ~ 6 Mos. Pre-Sep	PT ~ 1 Mo. Post-Sep	
Dorsiflexion (20 Normal)	20	0	
Plantar Flexion (45)	40	40	
Comment	+tenderness		
§4.71a Rating	0 or 10% (PEB 10%)	10%	
	
The Board directs attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under a combined 5024-5003 code (tenosynovitis; degenerative arthritis).  The VA used a combination of codes 5015 (bones, new growths of, benign) and 5271 (ankle, limited motion of), and assigned a 10% rating for moderate limitation of ankle motion.  Board members agreed that there was no evidence of “marked” limitation of motion; therefore a 20% rating was not justified under either the 5271 code or the 5003 code (which defaults to limitation of motion).  While the absence of joint ankylosis renders the 5270 and 5272 codes non-applicable, the 5273 (os calcis or astragalus, malunion of) and 5284 (foot injuries, other) codes were also debated.  The Board concluded that the ‘moderate deformity’ and ‘moderate’ descriptors under these codes most accurately depicted the condition, and therefore the 10% rating was justified.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic left heel pain condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chronic left heel pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Left Heel Pain	5024-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120415, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW 
                                        BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
          (b) CORB ltr dtd 17 Dec 13

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXXXXX former USMC

						       XXXXXXXXXXXXXXXXXX
	     					       Assistant General Counsel
		       (Manpower & Reserve Affairs)