RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201064 SEPARATION DATE: 20020104 

BOARD DATE: 20130221 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SGT/E-5 (54B2H/Chemical Operations Specialist), 
medically separated for chronic bilateral heel pain and chronic right shoulder pain with some 
overhead activity. He first noticed heel pain while playing basketball in 1996 with recurrent 
bilateral heel swelling in the area of the Achilles tendon and calves (posterior ankle). He had 
surgical excision of left calcaneal Haglund's prominence in December 1999 and of right 
calcaneal Haglund's in March 2000. He injured his shoulder in both 1994 and 1998 weight 
lifting and was confirmed to have a right rotator cuff tear, but deferred surgical repair at the 
time. Despite improvement post heel surgery he could not be adequately rehabilitated to meet 
the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. He was issued a permanent U3/L3 profile and referred for a Medical Evaluation 
Board (MEB). Impingement syndrome bilateral shoulders, tendinitis bilateral elbows and 
mechanical low back pain (LBP) conditions, identified in the rating chart below, were also 
forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated the bilateral heel and 
right shoulder pain as one unfitting condition, rated 10% with application of the US Army 
Physical Disability Agency (USAPDA) pain policy. The remaining conditions were determined to 
be not unfitting and therefore not ratable. The CI made no appeals, and was medically 
separated with a 10% disability rating. 

 

 

CI CONTENTION: “Upon my separation from the US Army I was only awarded a 10% disability. 
However, when I filed my claim for service related disabilities with VA I was awarded 60% 
service connected disability.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings 
for unfitting conditions will be reviewed in all cases. The mechanical LBP condition as inferred 
in the application for consideration meets the criteria prescribed in DoDI 6040.44 for Board 
purview; and, is addressed below, in addition to a review of the ratings for the unfitting 
conditions of chronic bilateral heel pain and right shoulder pain. The remaining conditions (left 
shoulder and bilateral elbow) rated by the VA at separation and inferred on the DD Form 294 
are not within the Board’s purview. 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 Army Board for Correction of Military Records. 

 


RATING COMPARISON: 

 

Service IPEB – Dated 20010911 

VA* (5 Mos. Post-Separation) – All Effective Date 20020105 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Bilateral Heel Pain 
& Chronic Right Shoulder 
Pain 

5099-5003 

10% 

Left Achilles Tendon (Haglund’s 
Deformity) 

5299-5271 

20%** 

20020620 

Right Achilles Tendon (Haglund’s 
Deformity) 

5299-5271 

20%** 

20020620 

Residuals Right Rotator Cuff 
Tear, Major 

5201 

30%** 

20020606 

Impingement Syndrome, 
Bilateral Shoulders 

Not Unfitting 

No VA Entry for Left Shoulder 

20020606 

Tendinitis Bilateral Elbows 

Not Unfitting 

No VA Entry 

20020606 

Mechanical Low Back Pain 

Not Unfitting 

Muscle Strain of Lumbar Spine 

5295 

10% 

20020606 

No Additional MEB/PEB Entries 

0% X 2 / Not Service-Connected x 5 

20020606 

Combined: 10% 

Combined: 60% 



*Derived from VA Rating Decision (VARD) dated 20020813 

**No change to ratings in subsequent VARDs based on follow-on C&P exams 

 

 

ANALYSIS SUMMARY: The PEB combined the chronic bilateral heel, and right shoulder pain 
conditions under a single code analogous to 5003 (degenerative arthritis) and rated 10%, 
relying on the USAPDA pain policy for not applying separately rated VASRD codes. IAW VASRD 
§4.71a, the Board must apply separate codes and ratings in its recommendations if 
compensable ratings for each condition are achieved. As elaborated below separate 
compensable ratings for chronic bilateral heel condition, and right shoulder condition are well 
supported by the evidence in this case. Having determined that separate ratings are 
warranted, however, the Board must also satisfy the requirement that each ‘unbundled’ 
condition was unfitting in and of itself. Not uncommonly, this approach by the PEB reflects its 
judgment that the constellation of conditions was unfitting and that there was no need for 
separate fitness adjudications, not a judgment that each condition was independently unfitting. 
The Board therefore exercises the prerogative of separate fitness recommendations in this 
circumstance, with the caveat that its recommendations may not produce a lower combined 
rating than that of the PEB. The Board’s threshold for countering Disability Evaluation System 
(DES) fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used 
for its rating recommendations, but remains adherent to the same DoDI 6040.44 standards 
referenced above. In this case, the bilateral heel and right shoulder impairments were well 
supported as unfitting by evidence from the narrative summary (NARSUM) and service 
treatment record (STR). As to the judgment as to whether each condition was independently 
unfitting, the commander’s statement did not specifically identify the medical conditions and 
only implicated the inability to lift more than 40 pounds, however the permanent profile 
identified all the conditions and further designated them with an upper extremity (U3) and 
lower extremity (L3) code. The profile limited the CI from: firing a rifle; KP, mopping or mowing 
grass; additionally no marching, lifting more than 20 pounds; no unlimited walking, running, 
bicycling or swimming; and only exercise at own pace. Separating the impairment related to 
the heels from the right shoulder requires undue speculation; and, there is clinical evidence of 
significant functional impairment referable to the bilateral heels and the right shoulder. After 
deliberation, all members agreed that the preponderance of the evidence demonstrated that 
each of the chronic pain conditions (bilateral heel and right shoulder), in isolation, would have 
rendered the CI incapable of continued service within his MOS; and, accordingly each merits a 
separate disability rating. 

 


Bilateral Heel Pain Condition. The MEB NARSUM notes the CI was referred for bilateral heel 
pain which interfered with his ability to fully perform military duties. The chronic bilateral heel 
pain was noticed after playing basketball in 1996. He complained of recurrent swelling of the 
distal Achilles tendons and distal calves after any strenuous activity such as jumping, running, or 
prolonged walking. Orthopedics evaluated and diagnosed bilateral Haglund’s prominence for 
which the CI opted for surgical excision, the left in December 1999 and right in March 2000. 
The postoperative course was without complications and he reported improvement of aching, 
but was unable to resume his activities due to bilateral heel/Achilles pain. He specifically noted 
the wearing of boots caused pain and swelling at approximately a quarter mile. Postoperative 
heel radiographs showed surgical changes, otherwise unremarkable. There were four range-of-
motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which 
the Board weighed in arriving at its rating recommendation; as summarized in the chart below. 

 

Ankle ROM 

In degrees 

(Normal) 

Ortho~14 Mo. Pre-Sep 

MEB ~12 Mo. Pre-Sep 

VA C&P ~5 Mo. Post-Sep 

VA C&P ~2 Yrs. Post-Sep 

Left 

Right 

Left 

Right 

Left 

Right 

Left 

Right 

Dorsiflexion (20) 

Full 

Full 

Full 

Full 

< 5 

< 5 

20 

15 

Plantar Flexion (45) 

Full 

Full 

Full 

Full 

restricted 

restricted 

30 

25 

Comment 

Tingling 

Tingling of scar; 

Tender Achilles; 

No redness; 

No edema; 

Normal toe and heel 
walk 

Pain with palpation 
along the incision lines 

Tender, walks with a 
limp, painful motion on 
the right not left 

§4.71a Rating 

10% 

10% 

20% 

20% 

0% 

10%* 



*Conceding painful motion §4.59 

 

At an orthopedic consultation, the CI stated he suffered from pain with shoes on bilateral 
Achilles’ tendons, and painful heel on right that he was unable to run. Physical exam revealed 
tingling over the incision sites, no swelling, and full ROM of the ankles. The examiner diagnosed 
Achilles tendonitis status post (s/p) Haglund’s surgery. The MEB NARSUM physical exam noted 
demonstrated FROM bilaterally; a right 4 cm longitudinal well healed surgical scar 
posterolateral aspect of right heel and a 6cm of the left heel, the scars bilaterally demonstrated 
tingling locally with light tapping of scar and tenderness over the distal aspect of Achilles 
tendon yet no redness or edema. Post-operative heel radiographs revealed surgical changes, 
otherwise unremarkable. The examiner documented his present status as minimal 
improvement of his complaints after extensive conservative and surgical treatment for Achilles 
tendinitis and further that he was unable to run, jump, march, do pounding sports/exercises 
and walk a quarter mile in boots without pain or swelling. 

 

At the VA Compensation and Pension (C&P) exam approximately 5 months prior to separation, 
the CI reported pain and discomfort since surgery which was relieved with modifying his shoe 
wear with inserts, physical therapy (PT), a reduction in normal activity and further reported he 
did not take medications. Physical exam demonstrated; normal midtarsal movement yet the 
subtalar and ankle joints were restricted in dorsiflexion, plantar flexion, inversion, and eversion. 
Pain was noted along the scar line of each foot at the area of the retrocalcaneal bursa, and 
palpation of the Achilles tendon presented a ropy, contracted, overplay to the tendon itself. A 
general medical examination a few days prior identified a wide gait. The examiner opined the 
CI had a chronic disability, unable to ambulate without great discomfort, was symptomatic in 
the morning and in great discomfort by the end of the day. 

 

At a later C&P examination on 11 May 2004, 2 years after separation, the CI reported swelling 
two to three times per week which resulted in difficulty walking, daily pain right worse than 
left, and use of a cane, intermittently. He took over the counter nonsteroidal anti-inflammatory 


medication (Motrin) elevated his legs and iced for relief of these flare ups. He was employed as 
a hospital IT technician with no job restrictions that was mostly sedentary. He reported being 
unable to run, stand for more than 30 minutes, walk more than one mile, squat, or wear hard 
shoes or tube socks, or tolerate direct pressure to his Achilles tendons. Physical examination 
revealed extreme sensitivity over a 3 cm well healed surgical scar of the lateral surface of the 
right Achilles tendon, and the tendon itself was tender. The left ankle showed less tenderness 
over a 4 cm well healed surgical scar on the medial surface of the Achilles tendon, 5/5 motor 
strength. There was no diminution of either ankle upon ROM repetitions, negative Deluca 
observations. There was a limping gait identified. 

 

The Board directs attention to its rating recommendation based on the above evidence. It is 
obvious that there is a clear disparity between these examinations, with very significant 
implications regarding the Board's rating recommendation. The Board thus carefully 
deliberated its probative value assignment to these conflicting evaluations, and carefully 
reviewed the service file for corroborating evidence in the 12-month period prior to separation. 
The Board utilizes VA evidence proximal to separation in arriving at its recommendations; and, 
DoDI 6040.44 defines a 12-month interval for special consideration to post-separation 
evidence. If there is VA evidence after this interval, it does not mean that the VA information is 
disregarded, as it could be a valuable source for clinical information and opinions relevant to 
the Board’s evaluation. There is not a reasonable accounting for progressively impaired ROM in 
the fairly short interval between the MEB and VA examinations; furthermore the 24 month VA 
evaluation demonstrates ratable data that is more similar to the MEB exam than that of the 5 
month VA exam. Therefore, based on all evidence and associated conclusions just elaborated, 
the Board is assigning proportionately more probative value to the MEB evaluation and to the 
evidence in the service treatment record proximate to the date of separation as the basis for 
the Board’s rating recommendations. 

 

This rating includes consideration of functional loss lAW VASRD §4.10 (functional impairment), 
§4.40 (functional loss), §4.45 (DeLuca), and §4.59 (painful motion). The Board first considered 
the PEB’s chosen analogous VASRD diagnostic code (DC) 5003 (arthritis, degenerative). The 
Board agreed there is no evidence of painful motion on the MEB exam to allow the minimum 
10% for each joint IAW §4.59. However, the Board agreed the X-ray evidence alone in both feet 
meets the 10% criteria under this code for the criteria “With x-ray evidence of involvement of 2 
or more major joints or 2 or more minor joint groups.” The Board considered the evidence and 
does not find support for ankylosis or moderate limitation of motion of the ankle for a higher 
rating under either DC 5270 (ankylosis of ankle) or the 5271 (ankle, limitation of motion), the 
VA’s chosen code. The Board notes this disability is not specifically listed in the rating schedule; 
therefore, it should be rated analogous to a disability in which not only the functions affected, 
but also anatomical localization and symptoms, are closely related. Therefore, the Board 
considered DC 5276 (flat foot acquired) as a close analogous code for a moderate pain on 
manipulation and palpation of the Achilles tendon and pain with the use of the feet, bilateral or 
unilateral for a 10% rating; and that the condition did not approach the severe rating without 
marked deformities or consistent limitations on joint movement. Finally, the Board considered 
a scar rating IAW §4.118—Schedule of ratings–skin. By precedent, the Board does not 
recommend separation rating for scars unless their presence imposes a direct limitation on 
fitness. The Board agreed the evidence supports the ability to wear boots, albeit for quarter 
mile only and the MEB exam further supports a tingling non painful linear scar of the left and 
right heel. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 
(reasonable doubt), the Board by a 2:1 vote, recommends a 10% rating for the bilateral heel 
pain condition. The single voter for dissent, recommended a 10% rating for both left and right 
heel pain conditions, but did not elect to submit a minority opinion. 

 

Chronic Right Shoulder Pain Condition. The MEB NARSUM noted that the CI injured his right 
shoulder when bench-pressing weights of about 300 pounds in May 1998. The shoulder gave 


way and became painful and he was treated conservatively with physical therapy. He 
continued to lift weights, but had pain on the anterior aspect of the right shoulder and his right 
arm felt weak. Orthopedic evaluation diagnosed right rotator cuff tear confirmed on magnetic 
resonance imaging (MRI) and surgical repair was offered. The CI opted to defer surgical repair 
pending MEB bilateral heel pain and lack of progressive symptoms since activities had been 
modified. There were four ROM evaluations in evidence, with documentation of additional 
ratable criteria, which the Board weighed in arriving at its rating recommendation as 
summarized in the chart below. 

 

Shoulder ROM 

In degrees 

(Normal) 

MEB ~12 Mo. Pre-Sep 

PT 11 Mo. Pre-Sep 

VA C&P ~5 Mo. Post-Sep 

VA C&P ~2 Yrs. Post-Sep 

Right 

Right 

Right 

Right 

Flexion (180) 

175 

135 

95 

75 

Abduction (180) 

90 

136 

110, 80 with repetition 
(Deluca) 

65 

Comments 

Weakness/atrophy 

Weakness 

No weakness 

No weakness, no Deluca, 
painful motion 

§4.71a Rating 

20% 

10% 

30% for major 

vs.20% for minor 

30% for major 

vs.20% for minor 



 

The MEB exam demonstrated tenderness of the acromioclavicular joint, positive provocative 
tests for rotator cuff pathology (Neer’s impingement sign and Speed test), decreased 
supraspinatus strength of 3/5 with slight atrophy of the supraspinatus and infraspinatus 
musculature and relief of pain somewhat with the relocation test. The provocative tests for 
bicep pathology were positive and the tests for shoulder instability were negative. The MRI of 
the right shoulder revealed degenerative changes at the acromioclavicular (AC) joint with 
subacromial space impingement, diminished space between the head of the humerus and the 
acromion due displacement of the humerus and findings compatible with supraspinatus rotator 
cuff tear, pathology of the infraspinatus and the biceps tendons. An electromyogram (EMG) 
revealed chronic neurogenic deficit relative to the muscles innervated by C7 and C8, right upper 
limb; furthermore, an MRI of the cervical spine was within normal limits. At the PT evaluation, 
the CI reported constant pain, was swimming and not weight lifting. The physical exam 
revealed some 4/5 shoulder weakness with pain, tenderness of the right AC joint and anterior 
shoulder and no instability. At the C&P exam, 5 months after separation, the CI reported 
occasional numbness in the right shoulder, neck and down to the hand. He further reported he 
wrote with his left hand. He was unable to lift overhead; had lack of endurance when using the 
arm; was able to lift, but not repetitively; and took over the counter nonsteroidal anti-
inflammatory medication (Ibuprofen) for pain relief. The C&P exam revealed crepitus, 5/5 
motor strength and positive Deluca observations with decreased ROM to 95 abduction, 80 
degrees with repetition. The 24 months post-separation VA exam corroborated the limited 
abduction seen in MEB and VA 5 months exam. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
evidence supports he uses the left hand with which to write and therefore the Board agreed 
the right shoulder is considered the minor/non-dominant hand for its rating recommendations. 
It is reiterated as above the Board is assigning proportionately more probative value to the MEB 
evaluation and the information in the service record proximal to the date of separation as a 
basis for the Board’s rating recommendations. The PEB and VA chose different coding options 
for the condition which had significant implications on the rating for the Board to consider. As 
stated above the PEB bundled all conditions as a single unfitting condition and assigned 10% 
rating with an analogous code to 5003. The Board agreed the X-ray evidence and painful 
motion of the right shoulder meets the minimum allowable 10% rating and there is no evidence 


of incapacitation episodes to support a 20% higher rating under this code. The VA assigned a 
30% major rating coded 5201 (arm, limitation of motion of) for limitation of motion midway 
between side and shoulder level which is consistent with the ROM criteria however is not 
consistent with the dominance handedness evidence. The Board considered the VA’s chosen 
code 5201 and agreed the PT ROM exam achieves the 10% rating and the MEB ROM exam 
achieve the 20% rating. The Board considered the other ratable data to include diminished 
strength, the X-ray evidence which is consistent for other shoulder pathology outside of rotator 
cuff to include; AC joint, humerus displacement and bicep tendon pathology. The Board agreed 
with the severity of the right shoulder’s pathology, the documented functional impairments 
and the VA ROM exams, which were similar to the MEB exam. Therefore, the Board concluded 
the right shoulder functional disability meets the 20% rating IAW VASRD §4.7 (higher of the two 
evaluations). The Board also considered the 5304 code (Group IV muscles which includes the 
rotator cuff muscles) and agreed the evidence clearly supports a moderate 10% rating for pain; 
however, when considering the other ratable data and functional impairments this condition 
approaches a moderate severe 20% rating. There is no evidence of ankylosis or deformity. The 
shoulder had normal stability with no recurrent dislocations; therefore, the evidence does not 
support a higher rating under 5200 nor 5202. After due deliberation, considering all of the 
evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability 
rating of 20% for the chronic right shoulder pain condition. 

 

Contended PEB Conditions. The remaining contested condition, not addressed above, 
adjudicated as not unfitting by the PEB is mechanical LBP. The Board’s first charge with respect 
to this condition is an assessment of the appropriateness of the PEB’s fitness adjudications. The 
Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 
(reasonable doubt) standard used for its rating recommendations, but remains adherent to the 
DoDI 6040.44 “fair and equitable” standard. This condition was not profiled; it was not 
implicated in the commander’s statement; and, was not judged to fail retention standards. It 
was reviewed by the action officer and considered by the Board. There was no indication from 
the record that this condition significantly interfered with satisfactory duty performance. After 
due deliberation in consideration of the preponderance of the evidence, the Board concluded 
that there was insufficient cause to recommend a change in the PEB fitness determination for 
this remaining contended PEB condition and, therefore, no additional disability rating can be 
recommended. 

 

 

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 chronic bilateral heel pain and chronic right 
shoulder pain was operant in this case and the condition was adjudicated independently of that 
policy by the Board. In the matter of the chronic bilateral heel pain condition, the Board 
recommends a disability rating of 10%, coded 5003-5276 IAW VASRD §4.71a. In the matter of 
the chronic right shoulder pain condition, the Board unanimously recommends a disability 
rating of 20%, coded 5201 for minor IAW VASRD §4.71a. In the matter of the mechanical LBP 
condition, the Board unanimously recommends no change from the PEB determination as not 
unfitting. 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; and, that the discharge with severance pay be recharacterized to reflect permanent 
disability retirement, effective as of the date of his prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic Bilateral Heel Pain 

5003-5276 

10% 

Chronic Right Shoulder Pain 

5201 

20% 

COMBINED 

30% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120621, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for XXXXXXXXXXXXXX, AR20130004077 (PD201201064) 

 

 

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 30% effective the date of the individual’s original medical 
separation for disability with severance pay. 

 

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: 

 

 a. Providing a correction to the individual’s separation document showing that 
the individual was separated by reason of permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 

 

 b. Providing orders showing that the individual was retired with permanent 
disability effective the date of the original medical separation for disability with 
severance pay. 

 

 c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will 
account for recoupment of severance pay, and payment of permanent retired pay at 
30% effective the date of the original medical separation for disability with severance 
pay. 

 

 d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 
and medical TRICARE retiree options. 

 

 

 

 

 

 

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 XXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)