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AF | PDBR | CY2013 | PD-2013-02445
Original file (PD-2013-02445.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02445
BRANCH OF SERVICE: Army  BOARD DATE: 20150715
SEPARATION DATE: 20070430


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Motor Transport Specialist) medically separated for chronic Achilles tendon pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or but was authorized to perform an alternate physical fitness test (per PROFILE). He was issued a permanent P3L3 profile and referred for a Medical Evaluation Board (MEB). The “sleep apnea” and “left Achilles tendon pain,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded five other conditions (low back pain, non-cardiac chest pain, hypertension, hypertension, hyperlipidemia, right ankle pain after exertion) for PEB adjudication. The Informal PEB adjudicated “chronic Achilles tendon pain” as unfitting, rated 0% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The PEB acknowledged the MEB found the sleep apnea condition to fail retention standards. The PEB determined the sleep apnea symptoms relieved by use of a CPAP to be not unfitting and not ratable. The remaining conditions were determined to be not unfitting and not ratable. The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

IPEB – Dated 20070313
 VA* - (~2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Achilles Tendon Pain 5024 0% Ruptured Left Achilles Tendon 5284-5024 10% 20070630
Other MEB/PEB Conditions x 6 (Not In Scope)
 Other x 6 (equals SC, NSC & deferred)
RATING: 0%
 RATING: 60%
* Derived from VA Rating Decision (VA RD ) dated 200 70921 (most proximate to date of separation ( DOS ) ) .

ANALYSIS SUMMARY:

Chronic Achilles Tendon Pain. The service treatment records documented that the CI‘s history of left Achilles pain developed after he tore his Achilles while playing basketball with his unit team in February 2000. He underwent uncomplicated repair surgery within 24 hours of the injury and was provided crutches prior to using a cam walker. The CI briefly participated in physical therapy to rehabilitate his tendon. An Orthopedic clinic entry dated 29 August 2000 documented the dorsiflexion of left ankle to 10 degrees (NL=20), plantar flexion to 50 degrees (45), and noted good healing of the surgical incision. Treatment records were silent going forward until May 2001, at which time the CI reported he experienced pain after running (he ran up to 4 miles about twice a week) and morning tightness. A 24 May 2001 entry documented that the CI was not taking any medication for his condition; however, given his complaint of pain, Motrin was prescribed and physical therapy was again recommended. The records again fall silent in June 2001 till April 2005. There were two treatment entries in 2005, and no additional treatment prior to the MEB. On 15 November 2006 case management documented the report of pain in both ankles and left foot that increased with running and in cold weather. His pain is relieved with ice and heat to the area. The MEB history and physical examination dated 30 October 2006 documented height of 71 inches and weight of 265 pounds. Left ankle examination recorded tenderness to palpation of the Achilles tendon and “decrease ROM”. The CI was not taking any medication for his ankle condition. The narrative summary (NARSUM) dated 11 January 2007 documented that the CI “continues to have problems with pain and inability to walk on uneven ground,” and when he does, his leg will give way. The CI indicated that he had pain issues with his right ankle if he exercises “vigorously.” Examination of the lower extremity noted absence of Achilles and patellar reflexes, and the examiner opined that dorsiflexion and plantar flexion of the left foot “seem to be normal,” but noted some giving way of the left foot with dorsiflexion and plantar flexion against resistance, opined to be secondary to pain in the Achilles tendon area. The examiner noted there had not been any imaging of the ankle.

The VA Compensation and Pension examination performed 2 months after separation documented a normal gait, weight of 280 pounds, absence of foot deformity and decreased patella reflex. The examiner recorded there was absence of objective evidence of the ruptured Achilles tendon, and opined that the condition had no impact on the CI’s occupational or daily activities. The CI’s profile allowed unlimited walking, biking, and swimming, and he could run at his own pace and distance. The commander’s performance statement did not implicate his ankle condition.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated 0%, coded 5024 (tenosynovitis), and noted the absence of limitation of motion. The VA rated the condition at 10% coded analogously 5024, noting that the VA exam did not support a compensable rating; however, granted the 10% based on the finding at the NARSUM that the CI could not walk on uneven ground and his report of pain. A rating of 10% under this code requires evidence of limitation of motion or identification of arthritis, which was not supported by the evidence at the time of separation. There were no other applicable codes to consider for a compensable rating. The Board considered the application of VASRD § 4.59 (painful motion), and all board members agreed the condition was compensable under this provision since the NARSUM documented pain on motion. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% IAW VASRD §4.59 for the left Achilles 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 Achilles tendon pain condition, the Board unanimously recommends a disability rating of 10%, coded 5024 IAW VASRD §4.59, 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:

CONDITION
 VASRD CODE RATING
Chronic Achilles Tendon Pain 5024 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131104 w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record









XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXXXXXXX , AR20150015851 (PD201302445)
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 10% 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                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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