RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00356
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20060406

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Combat Engineer, medically separated for “chronic right ankle pain and decrease in motion” with a disability rating of 10%.

CI CONTENTION:  “It costed me my military career and it also affected my physical and mental being.”  The applicant’s 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 – 20051220	VARD – 20060823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain and Decreased Range of Motion	5271	10%	Osteoarthritis S/P Right Distal Fibular Fracture	5010	10%	20060322	
PTSD	Not Unfitting	PTSD	9411	NSC	20060322	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right Ankle.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM) podiatry addendum, the CI fractured his ankle in October 2001 and suffered chronic pain.  He was not a surgical candidate.  Despite treatment, the CI’s ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.

During the MEB NARSUM podiatry addendum examination on 15 November 2005, approximately 5 months prior to separation, the CI reported being cleared to run after completing physical therapy but could only run 50 to 60 yards before the pain was unbearable.  He returned to physical therapy but was not able to return to full unit physical training.  He deployed to Iraq completing a 1 year tour of duty.  After his deployment, his duties required him to stand for 12 hours fully loaded at checkpoints and dismounted patrols.  His pain worsened averaging 8-9/10 in intensity.  The examiner cited other examination observations.  An examination performed 2 August 2005, 8 months prior to separation, was essentially normal except for flexible pes planus with mildly decreased ankle range of motion (ROM).  An examination performed 29 August 2005, 7 months prior to separation, documented an essentially normal right ankle except for pain and instability with toe-heel walking and surgical scar.  An examination dated 19 October 2005, 6 months prior to separation, revealed flexible pes planus, mildly decreased ROM.  A physical therapy examination, dated 21 October 2005, 6 months prior to separation, documented moderate decrease right ankle ROM with unaffected dorsiflexion but mild decrease plantar flexion.

The VA Compensation and Pension (C&P) examination was accomplished 1 month prior to separation.  The CI reported continuous right ankle pain, exacerbated by physical activity and relieved by Motrin and Valium.  His right ankle pain did not resulted in lost work time.  The right ankle examination revealed no inflammation, weakness, tenderness, abnormal movement or guarding of movement.  Bilateral ankle ROM was dorsiflexion 20 degrees (normal 20) and plantar flexion 45 degrees (normal 45).  X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 10%, coded 5271 (ankle, limited motion) for moderate limited motion of the ankle.  The VA assigned a 0% rating, coded 5010 (arthritis due to trauma); however, increased the rating to 10% retroactive to the date of original claim.  The Board agreed a higher rating of 20% with marked limited ROM entries was not supported by the evidence.  A 20% rating under code 5010 (arthritis, due to trauma) requires evidence of occasional incapacitating exacerbations was not supported by the evidence.  There was no objective evidence of poor weight bearing ankylosis or marked deformity to support a rating under codes 5272 or 5273  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic right ankle pain.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the PTSD condition was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The Board noted that the service treatment records for this condition were silent.  The VA C&P mental evaluation noted that the CI was prescribed anti-anxiety medication for his symptom of insomnia and that he had a good response.  It was noted that the CI was not engaged in any form of mental health treatment within the past year and had not been admitted to a hospital for psychiatric reasons, nor had he required any emergency room visits for psychiatric problems.  The PTSD was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  It was reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that this condition 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 PTSD condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic right ankle pain and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended post-traumatic stress disorder condition, the Board unanimously recommends no change from the PEB determination 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131230, 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, AR20160006631 (PD201400356)

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