RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00076
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20060113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Active Duty E4, Unit Supply Specialist, medically separated for “chronic right ankle pain” with a disability rating of 0%.

CI CONTENTION:  The PEB should have medically retired her based on the following conditions:  neck, heart murmur, high blood pressure, left wrist, urge to urinate, bilateral knees, lower back, foot arches, hammer toes, sleep apnea and breast reduction.  Her complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 PEB- 20051216	VARD - 20060818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	0%	Residuals, Right Ankle Injury with DJD and Peroneal Tendonitis	5271-5024	10%	20060806	
Major Depressive	Not Unfitting	Major Depressive Disorder	9434	30%	20060809	
Left Wrist Tenosynovitis	Not Unfitting	Left Wrist Tenosynovitis (Minor)	5215-5024	10%	20060806	
Intermittent Chronic LBP	Not Unfitting	Lower Back DJD	5242	10%	20060806	
Muscular Neck Pain	Not Unfitting	Cervical Spine DJD	5237-5242	20%	20060806	
Left Gluteus Maximus (Hip Area), Muscle Tenderness	Not Unfitting	Left Hip Strain	5299-5010	10%	20060806	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  The record showed that the CI injured her right ankle in November 2001, 3 months prior to her enlistment.  She had ankle pain in both basic and advanced training, but did not seek medical attention.  He was issued a profile for pregnancy in summer 2002.  In 2003, she deployed twisting her right ankle during physical fitness training.  On 4 September 2003 her X-rays were normal; however X-rays taken 4 May 2004 showed stress images with laxity of the lateral ligaments bilaterally.  Magnetic resonance imaging (MRI) on 7 June 2004 showed evidence of prior ligamentous injury and injury to the ankle.  An orthopedics examination 3 weeks later showed her ankle stable with normal gait.  A primary care examination on 19 August 2004 noted full-painful range-of-motion (ROM).  On 23 November 2004 repeat X-rays showed stress and instability bilaterally.  A bone scan on 13 December 2004 was normal.  At a podiatry examination on 20 May 2005 the CI reported recurrent ankle sprains.  The examination noted ankle instability and painful motion at ROM extremes.  A repeat MRI on 27 July 2005 showed the previously noted ligamentous injuries with cartilage degeneration.  On 28 July 2005, an orthopedic addendum for the narrative summary (NARSUM) noted instability and painful motion.  During the NARSUM examination performed 30 November 2005, 6 weeks prior to separation, she had full ROM in all planes; however, painful motion, ankle stability and gait were not documented.

At the VA Compensation and Pension (C&P) examination performed on 9 August 2006, 7 months after separation, the CI reported continued ankle pain which does not interfere with her activities of daily living, but was aggravated by prolonged walking or standing.  On examination, her gait was normal and she did not utilize assistive devices.  She had tenderness to palpation; her ROM was normal, pain-free and was not reduced with repetition.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the ankle at 0%, coded 5099-5003 (analogous to degenerative arthritis) with application of the US Army Physical Disability Agency’s Pain Policy.  The VA rated the ankle at 10%, coded 5271 (limitation of motion of the ankle) and 5024 (tenosynovitis), citing painful motion.  The Board majority considered the evidence and found no route to a rating higher than the 0% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the right ankle condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the major depressive disorder, left wrist tenosynovitis, low back pain, neck pain, and left hip muscle pain were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The conditions were not profiled or implicated in the commander’s statement.  None were judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the above contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the Board majority recommends no change in the PEB adjudication.  In the matter of the contended major depressive disorder, left wrist tenosynovitis, low back pain, neck pain, and left hip muscle pain conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.

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 20131218, 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, AR20160005824 (PD201400076)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA