RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-01117	
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060704

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “traumatic arthritis, right ankle,” with a disability rating of 0%.  

CI CONTENTION:  The CI contends that he was only rated for his right ankle, but should have been rated for sleep apnea, asthma, and PTSD as well.  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 - 20060515	VARD - 20080314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Traumatic Arthritis, Right Ankle… 	5010	0%	Status Post Arthroscopic Surgery Chip Fracture Talar Bone, Right Ankle with Residual Scars	5271	10%	20070724	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Traumatic Arthritis, Right Ankle.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in March 2004 while playing volleyball.  Diagnostic imaging showed torn ligaments, but no fracture.  The CI underwent right ankle surgery in August 2004 for osteitis chondritis dissecans and torn ligaments.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty and there was no other surgical procedure that would eliminate his pain so he was referred to the MEB.  The MEB forwarded “traumatic arthritis in right ankle with decreased range of motion” for PEB adjudication.  

At the orthopedic clinic visit on 3 August 2005, 11 months prior to separation and 12 months after surgery, the CI reported mild (2/10) right ankle pain.  The examiner noted that the CI’s motion was normal, but pain was elicited by motion.  There was no swelling, tenderness, or weakness noted and tests for ligamentous instability were negative.  His gait was normal and X-rays taken of the right ankle that day showed no abnormality, fracture, dislocation, or lesion.  At the time of the orthopedic evaluation on 27 December 2005, 6 months prior to separation, the CI complained of continued pain with axial loading (running/rucking/marching).  Examination demonstrated full active range of motion (ROM) and normal gait.  Follow-up examination on 11 January indicated that the examination was unchanged.  At the time of the physical therapy (PT) ROM study on 30 January 2006, 5 months prior to separation, the examiner recorded 0 degrees of dorsiflexion (normal 20 degrees) and 55 degrees of plantar flexion (normal 45 degrees) with pain in all planes of motion.  The MEB examination (recorded on DD Forms 2807 and 2808) dated 1 March 2006, showed that the CI had a normal lower extremity evaluation.  The MEB NARSUM on 27 April 2006, 2 months prior to separation, noted ankle pain rated at 5/10 with daily activities and 8/10 when aggravated.  The examiner referenced and reported the PT ROMs noted above.  Diagnostic imaging from April 2006 documented minimal soft tissue swelling and a small joint effusion.  

At the VA primary care clinic appointment on 6 November 2006, 4 months after separation, the CI reported chronic right ankle pain.  On examination the CI was noted to have full ROM, mild swelling, and diffuse tenderness to palpation over the right ankle.  The examination was silent in regards to painful motion.  At the 24 July 2007 VA Compensation and Pension (C&P) examination, performed 13 months after separation, the CI reported “stiffness upon awakening in the morning and swelling when upright for prolonged periods.”  He denied “weakness, heat, redness, giving way, lack of endurance, locking, fatigability and dislocation.”  He reported that he had no painful motion.  On examination there was no swelling, effusion, weakness, tenderness, subluxation or guarding of movement.  ROM study showed dorsiflexion of 20 degrees and plantar flexion of 45 degrees without pain.  The right ankle “joint function [was] not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.”  The examiner indicated tenderness in the objective factors for the ankle diagnosis.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, coded 5010 (arthritis, due to trauma, substantiated by X-ray findings), citing “…without ratable limitation of motion.”  The VA rated the right ankle condition 10%, coded 5271 (limited motion of the ankle), citing ROM was within the criteria for a non-compensable evaluation, but a 10% rating was assigned based on evidence of tenderness IAW 38 CFR 4.40 and 4.45 for functional loss (DeLuca).  In assigning probative value to the conflicting examinations, the Board noted that the VA examination was over one year remote from separation and therefore carried significantly lowered probative value.  However, the PT examination ROMs were not consistent with corroborating evidence e.g., gross ROM observations in the preponderance of outpatient notes applied the descriptors good, normal or full; with painful motion being noted in the bulk of notes including orthopedic notes and the NARSUM.  The Board considered that the entirety of the record indicated that at the time of separation there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the VA.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right ankle condition, coded 5010.  

BOARD FINDINGS:  In the matter of the right ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
Traumatic Arthritis, Right Ankle	5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, 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 XXXXXXXXXXXXXXXXXXXXX, AR2016001 0867 (PD201401117)

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,
accept the Board's recommendation to modify the individual's disability rating to 10%
without re-characterization 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:

CF:
( ) DoD PDBR
( ) DVA