RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1300643
BRANCH OF SERVICE:  Army	BOARD DATE:  20140430
Separation Date:  20041119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92Y/Unit Supply Specialist) medically separated for chronic left ankle pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The chronic left ankle tendonitis condition, characterized as “medically unacceptable” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated chronic left ankle tendonitis as unfitting, rated 0% with likely application of VA Schedule for Rating Disabilities (VASRD) guidelines.  The CI made no appeals and was medically separated.

CI CONTENTION:  “That the reason I was medical discharged was because of my conditions.  VA has awarded me for those conditions.”

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 chronic left ankle condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 Military Records.

RATING COMPARISON:

Service IPEB – Dated 20041018	VA - (2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5024	0%	Tendonitis Left Ankle	5271	20%	20050127	
No Additional MEB/PEB Entries	Other x2	20050127	
Combined:  0%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20050525 (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 reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using VASRD standards, based on ratable severity at the time of separation.

Chronic Left Ankle Pain Condition.  During Basic Training in July 2001, the CI sustained an initial injury to the left ankle during a road march.  She had repetitive sprain injuries to the left ankle during Basic Training which prevented resolution.  The left ankle X-rays on 3 February 2004 and 21 May 2004 were negative.  The bone scan of both feet showed no evidence of an occult fracture.  The left ankle magnetic resonance imagining scan was normal.  The CI was given a permanent L3 profile for chronic left ankle tendonitis and lower back pain.  The commander’s statement noted that the CI was unable to run long distances or complete the 2-mile run as part of the Army Physical Fitness Test (APFT); however, she was able to satisfactorily perform her MOS in her current assignment.  The MEB narrative summary (NARSUM) exam completed approximately 2 months prior to separation documented that the constant aching left ankle pain was aggravated by walking, running and prolonged standing.  She underwent treatment with non-steroidal anti-inflammatory drugs, rest, ice compression, elevation and use of orthotics.  The examiner noted that she could not do sit-ups, run a 2-mile event, walk or swim as alternate aerobic events; however she could perform push-ups and bike.  The physical exam findings are summarized in the chart below.  The NARSUM also documents that the CI disagreed with the commander’s assessment and she could not walk or run any length of time nor could she stand for a prolonged period of time.  The VA Compensation and Pension (C&P) exam accomplished approximately 2 months after separation documented that the CI had pain along the anterior joint line as well as recurrent sprains and needed to wear a lace up ankle brace for prolonged activities.  The examiner further documented that repetitive use caused more pain.  The physical exam findings are also summarized in the following chart.  There were two 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.

Left Ankle ROM (Degrees)	MEB 2.63 Mo. Pre-Sep	VA C&P 2.33 Mo. Post-Sep	
Dorsiflexion (0-20)	20 (30)	20	
Plantar Flexion (0-45)	45 (80)	15	
Comment	Normal strength; mild tender to palpation anterior lateral aspect; no instability	Normal Gait & strength; Pain with eversion; tenderness along peroneal tendon	
§4.71a Rating	0%	20%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the chronic left ankle condition as 5024 tenosynovitis and rated at 0%.  The VA coded the tendonitis left ankle as 5271 ankle, limited motion of and rated at 20% for “moderate.”  The CI was permanently profiled for the chronic left ankle tendonitis.  The MEB NARSUM exam indicated full ROM; however there was mild tenderness to palpation on the anterior lateral aspect of the left ankle.  The VA C&P exam demonstrated limited ROM, pain with eversion and tenderness along the tendons.  Both examinations were equally detailed and both were equidistant from the date of separation.  There was no interval historical event that would explain her worsening plantar flexion ROM measurement.  All pre-separation imagining studies were normal and her gait was normal 2 months after separation.  The file contained no evidence that would add probative value to one exam or the other.  The Boards considered the commander’s statement and the normal gait as indicators that the CI’s left ankle pain minimally impaired her.  The file did not contain any information directly demonstrating pain limited motion, except for the limitations outlined by the profile and the post-separation C&P exam.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and VASRD §4.59(Painful motion), the Board recommends a disability rating of 10% for the chronic left ankle 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.  In the matter of the chronic left ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5024-5003 IAW VASRD §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 her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Left Ankle Pain	5024-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130523, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			

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 XXXXXXXXXXXXXXXXXX, AR20140013369 (PD201300643)

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						     

CF: 
(  ) DoD PDBR
(  ) DVA