RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:    
CASE NUMBER:  PD1200294 
BOARD DATE:  20121101 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty AZ4/E-4 (AZ/Aviation Maintenance Administration), 
medically  separated  for  a  left  lower  limb  condition.    She  did  not  respond  adequately  to 
treatment and was unable to fulfill the physical demands within her Rating, meet worldwide 
deployment standards or meet physical fitness standards.  She was placed on limited duty and 

BRANCH OF SERVICE:   NAVY 
SEPARATION DATE:  20090930 

underwent a Medical Evaluation Board (MEB).  Reflex sympathetic dystrophy of the lower limb 

and nontraumatic rupture of other tendons of foot and ankle were forwarded to the Informal 
Physical  Evaluation  Board  (PEB)  IAW  SECNAVINST  1850.4E.    The  IPEB  adjudicated  complex 
regional  pain  syndrome  (CRPS),  left  foot  and  ankle  as  unfitting,  rated  20%  and  symptomatic 
posterior tibial tendinitis, left as a Category II condition with application of the Veteran’s Affairs 
Schedule for Rating Disabilities (VASRD), respectively.  The Navy defines Category II conditions 
as ‘contribute to the unfit.’  The CI made no appeals, and was medically separated with a 20% 
combined disability rating.   
 
 
CI CONTENTION:  “More evidence, additional conditions.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in the 
Department of Defense Instruction (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  symptomatic  posterior  tibial  tendinitis,  left  foot  condition  requested  for 
consideration and the unfitting CRPS, left foot and ankle conditions meet the criteria prescribed 
in  DoDI  6040.44  for  Board  purview,  and  are  accordingly  addressed  below.    The  remaining 
conditions  rated by the VA  at  separation  and  listed  on  the DD  Form  294  application  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 Board for Correction of Naval Records.   
 
 
RATING COMPARISON:   
 

Service IPEB – Dated 20090609 
Condition 

Code 

Rating 

VA (1 Mos. Pre-Separation) – All Effective Date 20091001 

Code 

Rating 

Exam 

Complex Regional Pain 
Syndrome, Left Foot and 
Ankle 
Symptomatic Posterior 
Tibial Tendinitis, Left Foot 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

 
 

8799-8724 

20% 

Condition 
Left Ankle Strain and 
Degenerative Arthritis, Status 
Post Fracture 

5010-5271 

10% 

20090826  

Cat 2 

Status Post Left Foot Fracture 

5299-5284 

Lumbar Spine Scoliosis 

5299-5239 
0% X 2 / Not Service-Connected x 1 

Combined:  20% 

0% 

10% 

20090826 

20090826 

 

  The  Department  of  Veterans’  Affairs  (DVA),  however, 

ANALYSIS SUMMARY:  The Board also acknowledges the CI's contention suggesting that ratings 
should have been conferred for other conditions documented at the time of separation and for 
conditions not diagnosed while in the service (but later determined to be service connected by 
the VA).  While the Disability Evaluation System (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. 
is  empowered  to 
compensate  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.  
 
Left Lower Limb Condition.  The Board deliberated the unfitting CRPS, left foot and ankle and 
the  Category  II  condition,  symptomatic  posterior  tibial  tendinitis,  left  foot  with  the  below 
discussion.  The CI sustained a left ankle and foot injury in February 2008 falling down a set of 
stairs and immediately heard a popping sound and had pain of the medial left ankle and foot.  
She  was  casted  for  9  weeks,  and  then  placed  in  a  Cam  Walker  and  given  a  trial  of  physical 
therapy.  The pain persisted and she was unable to bear weight, had decreased sensation of the 
foot  with  paresthesias  and  thus  underwent  further  evaluation  with  orthopedics  to  include 
several X-rays, Magnetic Resonance Imaging (MRI) studies and a Dexa scan.  With the totality of 
the  reports  and  exams,  the  orthopedic  examiner  diagnosed  posterior  tibial  tendonitis,  stress 
fracture and reflex sympathetic dystrophy (RSD), recommended a referral to a pain specialist 
and started her on a trial of Lyrica as she had failed a trail of Neurontin due to side effects, both 
of these medications were anticonvulsants used for pain disorders.  In October 2008 she was 
evaluated by pain clinic (anesthesia).  The examiner documented she had been in a Cam Walker 
for 6 months, used crutches for ambulation and was still unable to bear full weight as the pain 
was made worse with any walking or ambulating more than a few steps.  The examiner further 
documented  the  pain  was  completely  relieved  with  rest  and  elevation. 
  The  exam 
demonstrated an antalgic gait, intact motor and neurologic findings, able to heel and toe stand, 
tenderness  of  the  posterior  tibial  tendon  behind  the  medial  malleolus,  abnormal  cooler 
temperature  measurements  on  the  left  lower  shin,  ankle  and  distal  tibia,  no  allodynia  and 
normal  hair  distribution. 
  The  examiner  diagnosed  posterior  tibial  tendinopathy  with 
superimposed  CRPS,  type  I,  counseled  her  for  lumbar  sympathetic  nerve  blocks  as  she  had 
failed medication treatment and recommended a bone scan and nerve conduction (NCV) tests.  
Follow-up  evaluations  by  the  same  examiner  included  documentation  of  normal  NCV  and  3 
lumbar nerve blocks, the last in February 2009, which provided very brief pain relief.  The non-
medical assessment (NMA) documented the CI was not working in her Rating and was missing 
16 hours of work per week.  There were three goniometric 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.   
 

DOS 20090930 

Left Ankle ROM 

PT ~12 Mo. Pre-Sep 

MEB ~6 Mo. Pre-Sep 

Dorsiflexion (0-20⁰) 
Plantar Flexion (0-45⁰) 

10⁰(passive) 

#⁰ 

Comment 

Limited by pain 

#⁰ Pain at neutral 

30⁰ 

Painful Motion 

10% 

VA C&P ~1 Mo. Post-Sep 

 

20⁰ 
45⁰ 

Limited by pain 

10%* 

§4.71a Rating 

10% 
*With consideration of §4.59 painful motion. 

 
 
At the MEB exam, the CI reported medial pain of the ankle and foot, 7 of 10 in intensity, use of 
a crutch or cane for ambulation, but she was weight bearing as tolerated, which was less than 
50 percent of her body weight and her current medication was Lyrica.  The MEB physical exam 
demonstrated  the  left  foot  was  slightly  cooler  to  touch  than  the  contralateral  right  leg, 
hypoesthetic upon palpation of the entire left foot and ankle region, mobilized her left lower 

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limb muscles slightly less relative to the contralateral side with a volitional component due to 
pain,  exquisitely  painful  posterior  tibial  tendon  with  resisted  inversion,  unable  to  perform  a 
heel raise, pulses were palpable and minimal soft tissue edema.  In August 2009, a month prior 
to separation, the anesthesia examiner documented that bearing weight, standing and walking 
all seem to aggravate her discomfort and she continued to use a single crutch to aid her walk.  
The  exam  demonstrated  normal  neuromuscular  and  vascular  findings,  no  evidence  of 
significant  hyperpathia  or  allodynia,  no  focal  atrophy,  normal  ankle  mobility,  positive  Tinel’s 
sign noted across the tarsal tunnel on the left side and exquisite tenderness along the medial 
ankle.    The bone  scan  revealed  posttraumatic  changes  with a  mild uptake  around  the  ankle.  
The examiner diagnosised posttraumatic arthritis, left ankle and findings suspicious for tarsal 
tunnel syndrome of the left leg, this may appear as causalgia or CRPS, and recommended more 
specific nerve testing in order to consider a tarsal tunnel release.   
 
At  the  post-separation  VA  Compensation  and  Pension  (C&P)  exam  the  CI  reported  ankle 
symptoms,  as  often  as  2-3  times  per  day  lasting  for  up  to  3-4  hour  of;  weakness,  stiffness, 
swelling, redness, pain, lack of endurance, fatigability, and tenderness.  From 1 to 10 (10 being 
worst pain) the pain level was at an 8.  The symptoms were precipitated by physical activity, 
sitting for long periods, came spontaneously and were alleviated by rest.  Flare-ups resulted in 
functional impairment; can't walk, sleep, or sit, and limitation of motion of the joint; can't pull 
foot back (toes up in air) and no toe raises.  She had relief of pain with Ultram 50 mg enough to 
help  her  mentally  get  through  the  day  while  sitting  at  a  desk  longer  than  1  hour  and  the 
condition had not caused incapacitation over the past 12-months.  The CI also reported foot 
symptoms which included; significant pain located at the arch of foot to the heel of foot, up to 
the shin and the big toe, intermittently as often as 3-4 times per week, the pain level was at 7, 
exacerbated by physical activity and standing in place for more than 10 minutes with no arch 
support, relieved by massage and use of arch support.  At the time of pain she could function 
with medication.  The VA Compensation and Pension (C&P) exam demonstrated no edema of 
the  lower  extremities,  normal  gait,  no  abnormal  wearing  of  the  feet,  no  requirement  for 
assistive device for ambulation and further documented normal bilateral ankle and foot exams 
to included motor, neurologic, vascular and skeletal findings.  X-rays of the left foot (non weight 
bearing and weight bearing) were within normal limits.  X-rays of the left ankle were also within 
normal limits.  
 
The Board directs attention to its rating recommendation based on the above evidence.  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 
orthopedic MEB exam and compared the ratable data with the anesthesia exam completed one 
month prior to separation and agreed the anesthesia exam reflects a more specialized exam as 
well as being more proximate to separation and therefore considers this exam more probative 
than  the  MEB  exam.    Furthermore,  the  Board  notes  that  the  VA  exam  was  complete,  well 
documented, and similar in terms of ratable data to the anesthesia exam completed, however, 
the VA exam was more compliant with VASRD §4.46 (accurate measurement) and therefore the 
Board assigns the VA more probative value.  The PEB and VA chose different coding options for 
the condition which had some implications on the rating for the Board to consider.  The PEB’s 
20%  rating  under  8724  (Internal  popliteal  nerve,  paralysis,  neuralgia)  cited  CRPS  for  the  left 
ankle and foot for moderate pain.  This is consistent with §4.124a criteria which specifies to 
rate  according  to  the  most  affected  peripheral  nerve  with  the  maximum  equal  to  moderate 
incomplete  paralysis.    The  Board  considered  8725  (posterior  tibial  nerve  [tarsal  tunnel])  for 
more clinical specificity however the VASRD criteria are the same as for the 8724 code.  The 
Board agreed the evidence did not support a higher rating of 30% under code 8624 (neuritis 

severe).  The Board notes while the posterior tibial tendinitis was determined to be a Category 

II condition by the PEB, the chosen neurologic code subsumes the pain of both the ankle and 
the foot.  The VA chose to rate the residuals of the ankle and foot for moderate painful motion 
with residual degenerative arthritis as their exam showed an improvement of her CRPS with 

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residual arthritis and pain.  Often this approach results in a higher combined rating, however, in 
this case, the VA’s combined disability is lower than the PEB’s again likely consistent with the 
natural progression of improvement of the CRPS.   
 
The Board considered separate ratings for each joint and agreed the evidence did not support 
the 20% criteria of marked limitation of motion for the ankle under the 5271 code.  If the Board 
considered to separately rate the residual posterior tibial tendonitis of the foot, first the Board 
would be challenge with a fitness determination.  If the Board agreed the foot was separately 
unfit,  the  Board agreed the evidence  supports the  moderate 10%  rating  with  the 5284  code 
(Foot  injuries,  other)  for  a  combined  disability  of  20%  which  was  not  higher  than  the  PEB’s 
combined.  There was no evidence of documentation of incapacitating episodes which would 
provide  for  additional  or  higher  rating.    The  Board,  after  due  diligence,  found  no  additional 
route to any higher disability rating.  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  left  lower  limb  condition.  
Additionally, the Board supports no recharacterization of the PEB fitness adjudication for the 
symptomatic  posterior  tibial  tendinitis,  left  foot,  as  related  Category  II  diagnoses  since  the 
associated  impairments  overlapped  with  those  attributed  to  the  primary  diagnosis  and  is 

 
 
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  left  lower  limb  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:   
 

subsumed under that rating.   

VASRD CODE  RATING 
8799-8724 
COMBINED 

20% 
20% 

Complex Regional Pain Syndrome, Left Foot and Ankle 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120227, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

             
           President 
           Physical Disability Board of Review 

   4                                                           PD1200294 
 

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 26 Nov 12 
 
      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, 
for the reasons provided in their forwarding memorandum, 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: 
 
                  -  former USN  
-  former USMC 
 
-  former USMC 
 
 
-  former USMC 
 
-  former USMC 
  
     
 
 
 
 
 
 
 

  
Assistant General Counsel 
(Manpower & Reserve Affairs) 

 
      
 

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