Citation Nr: 0006431 Decision Date: 03/09/00 Archive Date: 03/17/00 DOCKET NO. 98-03 571 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to an increased rating for chronic left Achilles tendinitis. 2. Entitlement to an increased rating for chronic right Achilles tendinitis. REPRESENTATION Appellant represented by: Alabama Department of Veterans Affairs INTRODUCTION The veteran served on active duty from March 7, 1989, to June 20, 1989. This case first came before the Board of Veterans' Appeals (Board) from a rating decision of October 1997 by the Montgomery, Alabama, Regional Office (RO) of the Department of Veterans Affairs (VA), wherein a noncompensable rating for bilateral chronic Achilles tendinitis was confirmed and continued; and from a rating decision of March 1998, wherein a 10 percent rating for this disability was awarded, effective as of July 14, 1997, the date of receipt by VA of the veteran's claim for increased compensation. In August 1998, this claim was remanded by the Board for additional development of the evidence. The requested actions have been completed, and the case is again before the Board for appellate review. The Board notes that Achilles tendinitis is not a bilateral disorder, in the sense that Achilles tendinitis of each foot would be evaluated as one combined disability; rather, Achilles tendinitis of each foot is evaluated as a separate and distinct disorder. The current 10 percent rating has been assigned for a "bilateral" disorder; for that reason, and in view of the fact that the Board, in the instant decision, is assigning compensable ratings for each foot, the Board has not identified which foot of the "bilateral" disability is actually assigned the 10 percent rating now in effect. The Board also notes that the veteran, in the course of this appeal, has raised the issue of entitlement to service connection for chronic depression secondary to his service- connected Achilles tendinitis of each foot. This issue has not been addressed by the RO, and is referred to the RO for action as appropriate. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's claims has been developed. 2. Chronic left Achilles tendinitis is manifested primarily by marked limitation of motion; left ankle ankylosis is not shown. 3. Chronic right Achilles tendinitis is manifested primarily by marked limitation of motion; right ankle ankylosis is not shown. CONCLUSIONS OF LAW 1. The criteria for a rating of 20 percent, but no greater than 20 percent, for chronic left Achilles tendinitis are met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, §§ 4.40, 4.71a, Diagnostic Codes 5024, 5270, 5271 (1999). 2. The criteria for a rating of 20 percent, but no greater than 20 percent, for chronic right Achilles tendinitis are met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, §§ 4.40, 4.71a, Diagnostic Codes 5024, 5270, 5271 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board finds that the veteran's claims are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); that is, he has presented claims that are plausible. See Proscelle v. Derwinski, 2 Vet. App. 629 (1992) (application of the well-grounded standard for claims for increased compensation.) He has not alleged the existence of any records of probative value that may be obtained and which are not already associated with his claims folder. The Board accordingly finds that the duty to assist him, as mandated by 38 U.S.C.A. § 5107(a) (West 1991), has been satisfied. Service connection for a disability characterized as chronic Achilles tendinitis, bilateral, was granted by the RO in October 1989 following review of evidence that included the veteran's service medical records and the report of an August 1989 VA examination. The RO assigned a noncompensable evaluation for this disorder; in the course of the current appeal, the RO, in March 1998, increased this rating to 10 percent, effective as of July 14, 1997, the date of receipt by VA of the veteran's claim for a compensable evaluation. The veteran has continued his appeal. See AB v. Brown, 6 Vet. App. 35 (1993). As indicated above, the Board has determined that each foot is to be evaluated separately. The severity of a service-connected disability, such as chronic Achilles tendinitis, is ascertained by the application of criteria set forth in VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4 (1999) (Schedule). Pursuant to Diagnostic Code 5024 of the Schedule, tenosynovitis is rated on the limitation of motion of the affected parts, as analogous to arthritis. Under Diagnostic Code 5271, moderate limitation of ankle motion is considered to be 10 percent disabling, while marked limitation of motion is deemed to be 20 percent disabling. Under Diagnostic Code 5270, ratings greater than 20 percent can be assigned for certain degrees of ankylosis of the ankle. The report of the most recent clinical evaluation of the veteran's Achilles tendinitis, which was conducted by VA in December 1999, shows that he complained of persistent and severe ankle pain of such a nature that "[e]ven walking half a block or quarter of a block is more or less impossible. The pain is so severe it makes it so stiff that it is unbearable at times. Any trauma, any touch since it is so hypersensitive, or any kind of a movement of the ankle, stressing the tendon Achilles precipitates all these pains." It was noted that he wore an ankle/foot arthrosis "all the time." The report indicates, with regard to the veteran's left ankle, that range of motion (apparently plantar flexion) was possible from only 10 degrees to 30 degrees, "very gently done"; normal or full ankle plantar flexion ranges from 0 (zero) degrees to 45 degrees. See 38 C.F.R. § 4.71, Plate II (1999). Tenderness over the tendon Achilles was noted. With regard to the veteran's right ankle, the report indicates that range of motion (apparently plantar flexion) was "very much limited," with movement from the neutral position of 0 (zero) degrees to 30 degrees, compared to full or normal ankle plantar flexion of 0 (zero) to 45 degrees. The examiner noted that dorsiflexion of the right ankle was "more or less impossible." The examiner further noted that strength in each ankle was 3/5, attributable not only to the chronic Achilles tendinitis, but also to pain. The report indicates diagnoses to include chronic bilateral Achilles tendinitis, with moderately severe to severe functional impairment. The Board finds, based on the report of this examination, that the veteran's limitation of ankle motion, when considered in conjunction with the functional impairment demonstrated at that time, must be considered to be marked in nature with regard to each ankle. Diagnostic Code 5271; see 38 C.F.R. § 4.40 (1999) and DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board therefore concludes that a 20 percent rating for each ankle is appropriate. The Board, however, does not find that a rating greater than 20 percent can be assigned for either ankle, under Diagnostic Code 5270. The December 1999 VA examination report shows that movement, albeit limited, of each ankle was possible; neither this report, nor any other medical record, demonstrates that either ankle is ankylosed. ORDER A rating of 20 percent, but no greater than 20 percent, for chronic left Achilles tendinitis is granted, subject to the laws and regulations governing the disbursement of monetary benefits. A rating of 20 percent, but no greater than 20 percent, for chronic right Achilles tendinitis is granted, subject to the laws and regulations governing the disbursement of monetary benefits. M. S. SIEGEL Acting Member, Board of Veterans' Appeals