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AF | PDBR | CY2013 | PD-2013-02728
Original file (PD-2013-02728.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02728
BRANCH OF SERVICE: Army  BOARD DATE: 20150406
SEPARATION DATE: 20060730


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Armor Crewmember) medically separated for chronic right heel pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. The CI was permitted to take the swim portion of the alternate Army Physical Fitness Test. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The right heel condition, characterized as “right achilles tendon rupture, status post repair with chronic right achilles tendon pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were forwarded by the MEB. The PEB adjudicated the chronic right heel pain as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “According to VA im a disable vet because of disability due to military career.”


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 :

Service IPEB – Dated 20060613
 VA - based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Heel Pain 5024 10% S/P Right Achilles Tendon Rupture 5271 0% STR
Other x 0 (Not In Scope)
 Combined: 0%
Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 71106 ( most proximate to date of separation [ DOS ] ).



ANALYSIS SUMMARY:

Right Heel Condition. Treatment records evidence that the CI sustained a right Achilles tendon rupture on 1 May 2005. On 2 May 2005 the rupture was repaired. The CI underwent a course of post-operative physical therapy (PT). Eleven weeks after surgery a PT note documented noted mild improvement with plantar flexion to 40 degrees (normal 45 degrees), dorsiflexion to 14 degrees (normal 20 degrees), decreased dorsiflexion and plantar flexion strength (4/5), and calcaneal tenderness to palpation. A year after the surgical repair, the CI continued to report chronic right ankle pain. At the narrative summary examination dated 24 May 2006 the CI reported chronic, sharp ankle pain rated 4/10 baseline; rising to 8/10 during an exacerbation. Running, climbing, prolonged standing for more than half an hour, and mounting and dismounting a vehicle worsened that pain. The right ankle examination demonstrated plantar flexion to 20 degrees (66% of normal), dorsiflexion to 10 degrees (50% of normal), decreased inversion and eversion, pain on palpation at the Achilles tendon area, and a well healed surgical scar. A diagnosis of right Achilles tendon rupture, status post repair with chronic Achilles tendon pain was rendered and noted as not meeting retention criteria. A VA Compensation and Pension examination was not on record; however, the VARD referenced that the rating decision was based on the service medical records and exit examination. The goniometric range-of-motion evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.


Ankle ROM
(Degrees)
 PT ~12 Mo. Pre-Sep
(20050729)
 MEB ~2 Mo. Pre-Sep
(20060524)
Left Right Left Right
Dorsiflexion (20 Normal)
 No measure 14 20 10
Plantar Flexion (45)
 No measure 40 40 20
Comment
 Tenderness to palpation, decreased plantar and dorsiflexion strength Pain on palpation, decreased inversion and eversion.
§4.71a Rating
 N/A 1 0% N/A 10%

The Board directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the chronic right heel pain condition as unfitting with a disability rating of 10% for moderate ankle limitation of motion; coded 5271 (ankle limitation of motion). The VA also coded the condition 5271 and assigned a 0% rating for “status post right Achilles tendon rupture repair that is absent of moderate limited motion.” The Board considered whether there was evidence to support a higher than 10% rating for the condition. There was no evidence of marked ankle limitation of motion (5271), marked talus deformity (5273), or moderately severe foot injury (5284) for a higher rating. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the chronic right heel pain condition was appropriately recommended in this case. The Board concluded therefore that this condition could not be recommended for additional disability rating.


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 right 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131218, 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 , AR20150012736 (PD201302728)

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                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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