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AF | PDBR | CY2012 | PD 2012 00537
Original file (PD 2012 00537.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2012-00537
BRANCH OF SERVICE: Army  BOARD DATE: 20141113
SEPARATION DATE: 20040226


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SPC/E-4 (95B10/Military Policeman) medically separated for a bilateral foot condition. It could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, his profile indicated he could perform an alternate event for his physical fitness test. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The foot condition, characterized as “heel spur and Achilles' tendonitis bilaterally” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “chronic pain, both heels, due to bone spurs and Achilles tendonitis” as unfitting, rated at 10%, citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “1. Chronic pain and discomfort when idle or walking. 2. Unable to walk long distances or stand for long durations. 3. Unable to participate in physical activities that were routine, prior to the injuries (running, hiking, biking). 4. Possible side effect from long-term use of Etolodac. 5. Unable to afford suitable dental and healthcare due to limited income. 6. Treated for depression by VA Hospital and clinics due to inability to acquire suitable employment that accepts the limitations I received from deployment. 7. Due to my injuries, I am unable to perform my pre-deployment occupation, resulting in the ability to contribute to social security for retirement and my spouse having to provide income. 8. Denied the ability to retire from the Armed Forces that I worked so hard to acquire for my future with 20 years, 11 months invested. 9. The need to continuously wear braces for support needed to function throughout the day.”


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 rating for the unfitting bilateral foot condition is addressed below; no additional conditions, to include the contended depression, 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 Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.


R ATING COMPARISON :

Service IPEB – Dated 20031222
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Pain, Both Heels.. 5099-5003 10% Calcaneal Spur…Right Foot 5284* 10% 20040513
Achilles Tendonitis…Left Foot 5284* 10% 20040513
Other x 0 (Not in Scope)
 Other x 1* 20040513
Rating: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 40613 ( most proximate to date of separation)
Coding and “Other” conditions derived from 20070316 VARD since 20040613 RD not available in records.

ANALYSIS SUMMARY:

Chronic Foot Pain Condition. The service treatment record (STR) documents a history of a left ankle injury on 8 May 2003 while the CI was deployed. He had persistent pain and was evacuated from theater back to his home station in July 2003. X-ray images revealed changes consistent with chronic bilateral Achilles tendonitis. He was referred to podiatry services and the diagnoses of chronic bilateral Achilles tendonitis and plantar fasciitis were made. He was treated with medications, duty modification and orthotics, but was not able to return to full duty and therefore was referred for a MEB.

On the 19 November 2003 MEB exam, the CI was noted to be tender over the heel bones and Achilles tendons, right > left. In the 12 December 2003 (10 weeks prior to separation) MEB narrative summary by podiatry, the CI complained of bilateral heel pain since injury in May 2003. The inferior and posterior aspects of both heels were tender. Neurovascular status, muscle strength and reflexes were intact. Goniometer measured range-of-motion (ROM) showed 20 degrees dorsiflexion (normal) and 40 degrees plantar-flexion (5 degrees less than normal) for the right and left ankles. X-rays showed bilateral posterior heel bone spurs consistent with the diagnoses of bilateral Achilles tendonitis.

At the 17 May 2004 (10 weeks after separation) VA Compensation and Pension (C&P) exam, the CI complained of constant posterior heel pain. Pain was exacerbated by stretching and relieved by wearing heel braces and medication. Pain did not affect daily activities and there was no history of flare-ups. Repetitive use of the feet did not produce any discomfort and there was no instability. Physical exam documented the CI did not appear to be in pain, had good posture, did not use a cane and had a normal heel-toe gait. Exam of the feet showed no deformity, edema, callus or evidence of flatfeet. The Achilles tendons and plantar fascia were non-tender. The right heel bone was diffusely tender and the left posterior heel bone was tender. Foot X-ray images were normal other than small heel spurs bilaterally. The diagnoses listed the right foot as normal with a calcaneal (heel bone) spur and no evidence of plantar fasciitis, residual trauma or tendonitis. The left foot was listed as normal with a calcaneal spur, no evidence of plantar fasciitis or residuals of an avulsion fracture (bone fragment removed with a ligamentous injury), and evidence of chronic left Achilles tendonitis. The physician opined that the left Achilles tendonitis was causing residual pain and discomfort.

The Board first deliberated whether the left and right foot conditions were separately unfitting when considered individually. Although the initial injury was to the left ankle, the bilateral foot complaints were documented and addressed equally and concurrently. The orthopedic surgeon, podiatrist, profile, commander’s statement, MEB, and PEB implicated bilateral Achilles tendonitis plus or minus bilateral plantar fasciitis. The VA C&P exam noted only left foot Achilles tendonitis, but the VARD rated bilateral Achilles tendonitis and plantar fasciitis. The Board concluded that the constellation of findings from the STR, radiographic reports, and commander’s statement were sufficient to determine that the CI’s left and right foot conditions were separately unfitting.

The Board then directs attention to its rating recommendation based on the above evidence. The PEB rated the bilateral Achilles tendonitis, heel spurs, and chronic heel pain at 10% (Veterans Affairs Schedule for Rating Disabilities [VASRD] code 5003; degenerative arthritis) citing slight/frequent pain IAW USAPDA pain policy. The VA rated the bilateral Achilles tendonitis, heel spurs, plantar fasciitis and left foot fracture residuals as left foot at 10% and right foot at 10% using code 5284 (analogously to foot injuries, other) citing moderate symptoms. The code used by the PEB rates based on X-ray evidence of involvement of two or more major joints or two or more minor joint groups. The code used by the VA rates based on an assessment of impairment as moderate (10%), moderately severe (20%) and severe (30%).

Board members agreed that the limitations described and exam findings did not exceed the moderate level. The documented ROM did not support a minimal rating under 5270 (ankle, ankylosis of) or 5271 (ankle, limited motion of). There was no ankylosis for consideration under 5272 (subastragalar or tarsal joint, ankylosis of) or malunion for consideration under 5273
(os calcis or astragalus, malunion of). There was no excision of the astragalus for consideration under 5274 (astragalectomy). The Board considered 5276 (flatfoot, acquired) where mild (0%) indicates symptoms are relieved with orthotics. The Board noted the CI’s symptoms were not relieved with orthotics, but members agreed the condition did not exceed the moderate level (10%, unilateral or bilateral). The Board noted that both codes 5276 and 5284 were appropriate, but that the latter afforded a higher rating for the CI (20% vice 10%). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for each foot using the VASRD code 5284.


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. As discussed above, PEB reliance on the USAPDA pain policy for rating the chronic foot pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic left and right foot pain conditions, the Board unanimously recommends a disability rating of 10%, each, coded 5284 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Left chronic foot pain condition 5284 10%
Right chronic foot pain condition 5284 10%
COMBINED
 20%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120604, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB                                                                         

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXX , AR20150005533 (PD201200537)
1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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