RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201909 SEPARATION DATE: 20030510 

BOARD DATE: 20130131 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SGT/E-5 (91A20/Medical Repair Technician), 
medically separated for bilateral heel pain. He experienced an onset of bilateral heel pain in 
1999 after participation in an airborne operation. His condition was diagnosed as a Haglund’s 
deformity and Achilles tendonitis. The symptoms failed to respond to conservative measures, 
and could not be adequately rehabilitated to meet the physical requirements of the CI’s 
Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a 
permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded 
no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated 
bilateral heel pain, due to Haglund's deformity and Achilles tendonitis as unfitting, rated 0%, 
with cited application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI 
made no appeals, and was medically separated. 

 

 

CI CONTENTION: “Under the review, I was classified as having a condition called bilateral 
Haglund Deformity. I believe that this condition occurred because of 5 years of training in a 
highly deployable airborne unit, the 82nd Airborne Division. I refused surgical treatment 
because I did not want to interfere with the natural attachment of the tendon to the bone. 
Until this day, I cannot run without inflaming the tendon, and I must wear heel pads to 
minimize rubbing when walking. Its a painful condition. ” 

 

 

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 unfitting conditions will be 
reviewed in all cases. The bilateral heel pain, as requested for consideration, meets the criteria 
prescribed in DoDI 6040.44 for Board purview and is addressed below. 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 respective Army Board for Correction of 
Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20030317 

VA - (5 Mos. Post-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Heel Pain, Due to 
Haglund's Deformity and 
Achilles Tendonitis 

5099-5003 

0% 

Right Achilles Tendonitis with 
Haglund Deformity 

5024 

0% 

20031021 

Left Achilles Tendonitis with 
Haglund Deformity 

5024 

0% 

20031021 

No Additional MEB/PEB Entries 

Other x 5 

20031021 

Combined: 0% 

Combined: 40% 



VARD 20040214 (most proximate to Date of Separation) 

 

 


ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. While the DES considers all of the member's medical conditions, 
compensation can only be offered for those medical conditions that cut short a member’s 
career, and then only to the degree of severity present at the time of final disposition. The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or potential complications of conditions resulting in medical separation nor for conditions 
determined to be service-connected by the Department of Veterans Affairs (DVA) but not 
determined to be unfitting by the PEB. However, the DVA, operating under a different set of 
laws (Title 38, United States Code), is empowered to compensate all service-connected 
conditions and to periodically re-evaluate said conditions for the purpose of adjusting the 
Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is 
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 severity at the time of 
separation. 

 

Bilateral Heel Pain. The CI developed pain in the left heel in 1999. The diagnosis of Haglund’s 
deformity was made 21 March 2000. In October 2001, the CI first noted additional pain in the 
right heel. X-rays obtained 7 February 2002 confirmed calcifications at the insertion of both 
Achilles tendons confirming the diagnosis of Haglund’s deformity. On examination on 
22 August 2002 a small deformity only of the left heel was noted. In October 2002, 7 months 
before separation, the CI successfully completed a standard PT test. On 30 October 2002 the CI 
noted pain in both heels, with the left worse than the right. At a clinic visit on 1 November 
2002, the CI had pain in only the left heel. At the MEB/narrative summary (NARSUM) exam 
performed 8 January 2003, 4 months before separation, the CI reported bilateral heel pain 
described as occasional and moderate. On physical examination, small, tender masses were 
present at the Achilles tendon attachments to the heels bilaterally with left larger than the 
right. At the VA Compensation and Pension (C&P) exam 21 November 2003, 5 months after 
separation, the CI reported pain at the base of both heels. He noted no restrictions in any 
activity from the conditions; no requirement for pain medication or care by a podiatrist and no 
use of orthotics, or assists in ambulation. He reported running a mile and half every day and 
being able to bench press 300 pounds. On physical examination, tenderness was noted at the 
base of each Achilles tendon without shift in weight bearing line, callous formation or pronation 
deformity. Range-of-motion (ROM) of the ankles was normal without instability or 
incoordination. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB combined both heel conditions and rated as a single unfitting condition, 0%, code 5009-
5003, using the Army Pain policy. Not uncommonly this approach by the PEB reflected its 
judgment that the constellation of conditions was unfitting, and there was no need for separate 
fitness adjudications or implied adjudication that each condition was separately unfitting. The 
VA rated the ankle conditions each separately at 0% coded 5024, tenosynovitis, citing normal 
ankle ROM. The Board considered unbundling the PEB adjudication for individual ratings. The 
Board, in this circumstance, maintains the prerogative of separate fitness recommendations, 
with the caveat that its recommendations may not produce a lower combined rating than that 
of the PEB. The Board first addressed the fitness of each individual heel condition. The Board 
opined that both heel conditions were symptomatic and prevented the CI from performing the 
duties of his MOS as documented in the profiles, commander’s statement, and NARSUM. The 
Board then considered the appropriate rating for the individual right and left heel conditions. 
The Board agreed that neither heel condition was compensable under code 5024 based ROM. 
The Board noted that both heel conditions were mildly tender on examination throughout the 
record with left greater than right. The Board considered rating under §4.59 (painful motion) 
but opined that the absence of impact on functional activity, activities of daily living and 
exercise documented in the record did not rise to the 10% disability level for either heel 
condition. The Board concluded that the record in evidence supported a 0% rating for each 


heel. The Board further agreed that the minor deformities of the heel bones (Haglund’s 
deformity) were related to the tendinitis of the Achilles tendon at the site of attachment, and 
were an integral part of the heel condition, not subject to additional rating IAW VASRD §4.14 
(avoidance of pyramiding). The Board was unable to find a pathway to any higher rating under 
any other applicable VASRD coding. 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 bilateral heel pain condition as 
any change in coding, or individual rating after unbundling, provided no benefit to the CI. 

 

 

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 bilateral heel pain condition was operant in this 
case and the condition was adjudicated independently of that policy by the Board. In the 
matter of the bilateral 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 

Bilateral Heel Pain Due to Achilles Tendonitis with Haglund’s 
Deformity 

5099-5003 

0% 

COMBINED (w/ BLF) 

0% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20121107, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

xxxxxxxxxxxxxxxxxxxxxx, DAF 

Acting Director 

Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130007496 (PD201201909) 

 

 

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 and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)