RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00003
BRANCH OF SERVICE:  Army	BOARD DATE: 20150212
SEPARATION DATE:  20051220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Automated Logistics Specialist) medically separated for bilateral ankle condition.  These conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Degenerative joint disease (DJD) bilateral ankles with chronic painful ankles, characterized as “falling below retention standards,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions.  The Informal PEB adjudicated chronic bilateral ankle pain as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “At the time my right and left foot and ankle were diagnose as just bilateral ankles.  Instead it should have been my R/L foot and ankles were all degenerative arthritis joint disease.  The severity of all injuries was worse than perceived.  Arthritis was in both feet and ankles and worse than thought.”

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 Veterans Affairs Schedule for Rating Disabilities (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 20051014	VA* - (~2.5 to 3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Ankle Pain	5010	10%	Right Ankle DJD	5010-5284	10%	20060317
20060306	
			Left Ankle DJD	5010-5284	10%	20060317
20060306	
Other x 3 (Not in Scope)	Other x 10	
Combined:  10%	Combined:  70%	
*Derived from VA Rating Decision (VARD) dated 20060420 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Chronic Bilateral Ankle Pain.  According to service treatment records and the MEB narrative summary the CI developed degenerative arthritis of both ankles associated with recurrent ankle injuries and two surgeries on the right ankle in November 1997 and May 2000.  X-rays in March 2005 and April 2005 demonstrated degenerative arthritis of both ankle joints.  At the time of the MEB examinations in August 2005, the CI reported bilateral ankle pain, right more than left with prolonged standing and walking or running.  At the MEB examination on 3 August 2005 (DD Form 2808), dorsiflexion of both ankles was 0 degrees (normal 20 degrees) and plantar flexion was 35 degrees (normal 45 degrees).  At the orthopedic MEB examination on 29 August 2005, dorsiflexion of both ankles was 0 degrees.  Plantar flexion of the right ankle was 20 degrees and 30 degrees in the left ankle.  Three was no joint instability.  There was a limping gait favoring the right ankle.  The VA Compensation and Pension (C&P) examination from March 2006, 3 months after separation, was not available in the file; however, the VARD on 20 April 2006, recorded the results of the C&P examination.  According to the VARD the CI reported bilateral ankle pain with use.  The range-of-motion of both ankles was normal, and there was no swelling.  However, there was a limping gait and X-rays demonstrated degenerative arthritis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic bilateral ankle pain secondary to degenerative arthritis 10%, coded 5010 (arthritis due to trauma) citing ankle pain as the reason for unfitness (not limitation of motion).  VASRD diagnostic code 5010 is rated under code 5003 (degenerative arthritis) which provides for a single 10% rating for two or more major joints when there is not limitation of motion which supports a separate rating.  Although the VA C&P examination was reported to show no limitation of motion, the Board considered the limitation of motion at the MEB examinations to approximate a moderate limitation of motion.  While the PEB cited the limitation of motion as not the unfitting feature of the bilateral ankle condition, the Board concluded there was sufficient evidence of functional loss (§4.40) for each ankle to support a 10% rating for each ankle.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.40 (functional loss), the Board recommends a separate 10% disability ratings for the right and left ankle post-traumatic DJD (5010).

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 bilateral ankle pain secondary to degenerative arthritis, the Board unanimously recommends a separate disability ratings of 10% for the right and left ankle coded 5010 IAW VASRD §4.71a for a combined rating of 20% (with application of the bilateral factor).  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:

UNFITTING CONDITION	VASRD CODE	RATING	
Right Ankle Pain Secondary To Degenerative Arthritis	5010	10%	
Left Ankle Pain Secondary To Degenerative Arthritis	5010	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131217, 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 XXXXXXXXXXXXXXX, AR20150011025 (PD201400003)

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 20% 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		     XXXXXXXXXXXXXXX
		     Deputy Assistant Secretary of the Army
		         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA