RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00036
BRANCH OF SERVICE:  Army	BOARD DATE:  20150421
SEPARATION DATE:  20071120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Officer Candidate) medically separated for left ankle condition.  This condition could not be adequately rehabilitated to meet the physical requirements of officer candidate school.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “fracture left ankle” was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic pain, left ankle” as unfitting, rated 10% with cited application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “My injury has led to chronic back pain which requires frequent visits to a chiropractor.  This pain is caused by a change in my gait/walk as a result of my injury.”

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:

IPEB – Dated 20071018	VA* - (3 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Ankle	5099-5003	10%	Left Ankle Pain…	5271	10%	STR	
			Surgical Scar, Left Lower Extremity	7802	0%	STR	
Other x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080207 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Chronic Pain, Left Ankle.  Treatment records evidence that the CI sustained a left ankle fracture on 10 July 2007.  He underwent surgical reduction and fixation on 12 July 2007 and a post-operative course of physical therapy (PT).  The narrative summary examination on 23 August 2007, 6 weeks after surgery noted reports of persistent left ankle pain.  The CI required the use of a cane and a Cam walker for ambulation, pain and 4/10 pain that was controlled with daily use of anti-inflammatory medications.  The physical examination revealed an antalgic gain, “the usual postoperative stiffness,” and minimal localized soft tissue swelling.  A PT note dated 10 September 2007, approximately 2 months after surgery and 2 months prior to separation, noted 5 degrees left ankle dorsiflexion (normal 20 degrees) and plantar flexion to 45 degrees (normal 45 degrees).  An orthopedic note dated 13 September 2007 noted that the CI had no further ankle pain and was capable of full weight bearing ambulation without CAM walker.  The examiner noted that the fracture was clinically and radio-graphically united with an intact ankle joint.  A physical examination note, for the MEB, dated 20 September 2007, approximately 2 months prior to separation, documented continued reports of left ankle pain.  The examiner noted pain with ankle motion, weakness, and observed tenderness on ambulation.  There was no instability.  The CI cancelled the VA Compensation and Pension examination and was assigned a VA rating based on the medical records.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated that chronic left ankle pain condition as unfitting.  The PEB and VA rated the condition at 10%.  The PEB applied the USAPDA pain policy and coded the condition analogous to degenerative arthritis; 5099-5003.  The VA rated the condition based on ankle limitation of motion; coded 5271.  The Board considered whether the evidence supported a higher than 10% rating.  The Board noted that prior to separation the CI was able to ambulate without assistive devices; however there was observed pain with ambulation.  There was no evidence of marked limitation of motion, ankylosis, or occasional incapacitating pain exacerbation for a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board agreed that a disability rating of 10% for the chronic left ankle condition was appropriately recommended 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.  As discussed above, PEB reliance on the USAPDA pain policy AR 635-40 DoDI 1332.39 for rating chronic left ankle pain condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the chronic left 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131224, 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, AR20150013246 (PD201400036)

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