RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1300275
BRANCH OF SERVICE:  Army	BOARD DATE:  20140228
SEPARATION DATE:  20080215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (19D10/Cavalry Scout) medically separated for right ankle pain condition.  The injury occurred while the CI was deployed in 2005.  He received physical therapy (PT) and surgery in 2006, but the condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The chronic right ankle pain was forwarded to the Physical Evaluation Board (PEB) as not meeting medical standards IAW AR 40-501.  Anxiety disorder, not otherwise specified (NOS) and alcohol dependence were also submitted by the MEB.  The Informal PEB (IPEB) adjudicated chronic right ankle pain condition as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The anxiety disorder NOS was determined to be not unfitting and the alcohol dependence did not constitute a physical disability.  The CI made no appeals and after two administrative corrections to the IPEB DA Form 199, he was medically separated.

CI CONTENTION:  “Upon further medical examination and additional surgery.  Applicant is required to wear a prosthetic brace for his R ankle.  It is not recommended that an additional surgery would benefit condition.  Reason for discharge was nerve damage on review.  The nerve was damaged but the original surgery had also failed.”

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 rating for the unfitting right ankle condition is addressed below.  The not unfitting anxiety disorder NOS and alcohol dependency condition (adjudicated as a condition not constituting a physical disability) were not contended; and therefore, not within the Board’s purview.  These, and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veteran Affairs, operating under a different set of laws.

RATING COMPARISON:

Service IPEB (Admin) – Dated 20090219	VA* - (3 to 4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	DJD, Right Ankle	5010-5271	10%	20080521	
			Peroneal Neuropathy RLE	8621	10%	20080521	
Anxiety d/o, NOS	Not Unfitting	PTSD	9411	100%	20080612	
Alcohol Dependency	No Physical Disability	No Corresponding VA Entry	20080521	
No Additional MEB/PEB Entries	Other x8	20080521	
Combined:  10%	Combined:  100%	
*Derived from VA Rating Decision (VARD) dated 20080807 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus 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 ratable severity at the time of separation.

Chronic Right Ankle Pain.  The CI initially injured his right ankle when he jumped down from a wall while deployed in December 2005.  Three weeks later, he was evaluated and diagnosed with an ankle sprain and treated conservatively.  He subsequently suffered two additional right ankle sprains and was referred to orthopedics for management.  Plain film X-rays did not demonstrate any fractures; however, multiple boney fragments were seen that represented either old injury or a normal variant finding.  The CI was treated by PT but continued to complain of a painful ankle with “popping.”  He was given a temporary L2 profile and had to complete the alternative/walking physical fitness test which increased his pain.  He noted soreness and stiffness, popping and difficulty getting comfortable at night with aggravating activities of prolonged standing, yard work, standing on hard surfaces resulting in 8/10 right ankle pain.  A magnetic resonance imaging study was performed and revealed fluid in the ankle joint with an abnormal ankle ligament.  Definite ankle instability was demonstrated in October 2006 when a stress X-ray exam revealed a tilting of one of the ankle bones to 20 degrees (normal is 5-9 degrees).  In November 2006, the CI underwent a surgical reconstruction of the lateral ankle ligaments.  After months of post-operative rehabilitation, the CI stated that his ankle felt more stable but he still had significant pain and limited motion of the ankle.  He also complained of a “burning” type of pain with decreased sensation at the lateral aspect of the right foot.  He underwent nerve conduction studies of the right foot that revealed a neuropathy of the right, superficial peroneal nerve and a mild abnormality of the right sural nerve (both nerves innervate the lateral aspect of the foot).  Repeat plain film X-rays showed postsurgical and/or post-traumatic changes with degenerative changes.  There was soft tissue swelling without fracture or dislocation.  The CI’s ankle did not respond to any treatment modality and he was referred for MEB in June 2007.  The MEB medical exam (DD Form 2808), prepared approximately 7 months prior to separation, demonstrated decreased ROM of the right ankle with pain on motion and weight bearing.  At the MEB NARSUM exam, approximately 6 months prior to separation, the CI reported significant pain and recurrent episodes of instability of the right ankle.  The NARSUM examiner diagnosed chronic right ankle pain, stiffness and recurrent instability, and noted that the CI was unable to run, jump, ruck, march, carry his field gear or perform several of his functional soldier tasks.  The physical exam findings are summarized in the chart below.  The VA Compensation and Pension exam, accomplished approximately 3 months after separation, confirmed the history noted above with the CI identifying the unstable right ankle and the neuropathy.  The physical exam findings are summarized in the chart below.

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below:

Right Ankle ROM (Degrees)	PT 6 Mo. Pre-Sep	NARSUM 6.2 Mo. Pre-Sep	VA C&P 3.2 Mo. Post-Sep	
Dorsiflexion (20 Normal)	5	10	10	
Plantar Flexion (45)	45	30	45	
Comment	Pos. painful motion & tenderness to palpation over the achilles tendon area	Pos. painful motion with spasm, contracture and tremor	Pos. tenderness to palpation; Normal strength; Negative Deluca	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB applied the analogous VASRD code of 5099-5003, degenerative arthritis and rated it 10% disabling consistent with application of §4.59, painful motion, when there are non-compensable ROM measurements.  The VA applied VASRD code 5010-5271, limited motion of the ankle, and rated it 10% disabling consistent with a “moderate” limitation of motion.  The two rating codes mentioned above, 5003 and 5271, are the two most appropriate codes that can be applied in this case and both result in a 10% rating.  A 20% rating under each code can only be supported by evidence showing “incapacitating episodes” or a “Marked” limitation of motion respectively.  The evidence present for review does not support a 20% rating under either code.  The Board additionally considered if the residual peripheral neuropathy warranted an additional disability rating; but, members agreed that the requisite link of the neuropathy with functional impairment was not in evidence.  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 ankle pain condition was appropriately adjudicated in this case.

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 ankle 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	
Chronic Right Ankle Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130507, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
SFMR-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 XXXXXXXXXXXXXXXXXX, AR20140009333 (PD201300275)

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						     

CF: 
(  ) DoD PDBR
(  ) DVA