RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00458
BRANCH OF SERVICE:  Army                                                             SEPARATION DATE:  20060616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Combat Engineer, medically separated for “chronic left ankle pain and instability,” with a disability rating of 10%.   

CI CONTENTION:  “I have been rated at 100% through the VA.  When I originally did medical board my medical records and doctors were unavailable at time of separation”.   The CI’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 – 20060616	VARD - 20070530  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain and Instability, Left Ankle…	5099-5003	10%	Residuals Of Left Ankle Reconstruction	5271	10%	20070328	
Right Wrist Pain	Not Unfitting	Right Wrist Injury	5215	DEF	20070328	
Posttraumatic Stress Disorder	Not Unfitting	Intermittent Explosive Disorder, Obsessive Compulsive
Disorder, and Post-Traumatic Stress Disorder	9499-9411	DEF	20070328	
Obsessive Compulsive Disorder	Not Unfitting					
Intermittent Explosive Disorder	Not Unfitting					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Pain and Instability, Left Ankle Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic pain and instability, left ankle condition began in September 2000 after a fracture that caused a ligamentous rupture.  He was determined to have a chronically unstable left ankle and was a surgical candidate.  However, he was deployed to Kosovo in March 2001, Afghanistan in January 2002, and to Iraq.  He had so much trouble he redeployed early and had a procedure to reconstruct the left ankle in January 2004.  Despite physical therapy and rehab he continued to have considerable pain and instability.  Further ligamentous reconstruction was recommended and the procedure was performed successfully in May 2005.  He re-fractured the ankle in September 2005 during a follow-up visit.  He experienced constant pain, instability and recurrent bleeding from the surgical site which continued to re-open.  He was unable to perform his duties as a Soldier.  

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 30 March 2006, 3 months prior to separation, the CI reported constant pain and instability with episodic swelling of the left ankle and the need to wear an ankle brace for activities of normal daily living.  The left ankle had scarring with bony deformity and he retained hardware in left ankle.  

Orthopedics examination for MEB substantiation, dated 15 February 2006, showed a slightly antalgic gait and guarding of the left lower extremity during weight bearing but he walked without assistive aids.  There was marked scarring of the left ankle over the lateral bone consistent with multiple surgeries.  There was considerable tenderness and pain with palpation on passive/active movement.  Range of motion (ROM) showed dorsiflexion to 0 degrees (normal 20) and plantar flexion to 45 degrees (normal 45) by goniometer.  The examination other than the pain was normal.  X-rays showed post-surgical changes post-surgery with four screws in the mid distal fibula.  There was a small avulsion fracture of the tip of the fibula on the left ankle with normal anatomic alignment.  There was no subluxation, fracture, dislocation or arthritic changes.  Final diagnosis was left ankle pain and instability.  

The commander’s statement noted the CI was not able to perform his duties and was unable to conduct the fitness test including alternate events.  He was working normal duty hours in another assignment, supervising construction and mentoring two soldiers.  The March 2007 C&P general medical examination, 9 months after separation, noted posture and gait were normal and he was able to walk on heels and toes without any abnormalities noted.  The VARD noted he did not report for the specialty orthopedic examination for the ankle.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition 10% coded 5099-5003 (arthritis, degenerative.)The VA rated the ankle condition 10% coded 5271 (ankle, limited motion of), based on the VA C&P general examination, citing moderate limited motion.  The CI sustained two fractures of the left ankle and had two reconstructive surgeries but was able to walk without assistive aids.  Board members agreed that the limitation of ankle motion documented in the service and VA examinations was moderate, and therefore the next higher 20% rating was not justified.  Since ankle ankyloses was not present, a higher rating was likewise not justified under the 5270 or 5272 codes.  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 ankle condition.  

Contended PEB Conditions. Right Wrist Pain, Posttraumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder, Intermittent Explosive Disorder.  Psychiatric evaluation March 2006 noted the CI did not meet criteria for PTSD although he had signs of anxiety, including irritability and nightmares.  From a psychiatric perspective he met retention standards.  The right wrist pain, PTSD, obsessive-compulsive disorder, intermittent explosive disorder conditions were not profiled or implicated in the commander’s statement and were not 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 determinations for the  contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left ankle pain and instability condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right wrist pain, PTSD, obsessive-compulsive disorder, intermittent explosive disorder 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 20140103, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 
XXXXXXXXXXXXXXXXXXXXX AR20160010961 (PD201400458)

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