RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01183
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E7, Intelligence Analyst, medically separated for “chronic left ankle pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI stated requests that the Board review all of his MEB/PEB conditions.  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 - 20070523	VARD - 20080220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Ankle Pain	5099-5003	10%	Tendonitis, Left Ankle	5099-5271	10%	20070908	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	10%	20070908	
Anemia	Not Unfitting 	Anemia	7700	0%	20070908	
Irregular Periods	Not Unfitting	Dysmenorrhea	7699-7629	NSC	20070908	
Hearing Loss	Not Unfitting	Hearing Loss, Right Ear	6100	NSC	20070908	
Functional Heart Murmur	Not Unfitting	No VA Placement	
Insomnia	Not Unfitting		
Wheezing After Exertion	Not Unfitting		
Vision Impairment	Not Unfitting		
Occasional Wrist Pain	Not Unfitting		
Occasional Chest Pain	Not Unfitting		
Elevated Cholesterol	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Ankle Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in 2000 while in basic training where she suffered several minor sprains.  The CI had recurrent left ankle sprains including left tibia stress fractures and dorsal foot tendinitis.  She re-injured her left ankle in 2005 while deployed, and developed chronic ankle pain.  At the time of the foot and ankle specialist evaluation in January 2007, the CI had not benefited from conservative therapy.  Examination showed that she had a normal gait and normal shoe wear with no significant foot or ankle swelling.  Range-of-motion (ROM) was full with some tenderness.  Diagnostic imaging was repeated in February 2007 and showed mild tendonitis and swelling, but otherwise normal findings.  It was determined that there was no surgical indication.  Despite treatment, (profiles, steroid injections, oral steroids, physical therapy, splints and casting), the CI’s left ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a MEB.  The MEB forwarded “left ankle pain” for PEB adjudication.  

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Left Ankle ROM
(Degrees)	MEB ~4 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
Dorsiflexion (20 Normal)	5, 5, 5	15	
Plantar Flexion (45)	28, 30, 32	30	
Comment	Tender	Painful motion; abnormal gait	
§4.71a Rating	10%	10%	

At the MEB examination (recorded on DD Form 2807 and 2808) dated 15 March 2007, 3 months prior to separation, the CI complained of left ankle pain with periodic swelling, having been casted from March-April 2006 (7 weeks), followed by a cam-boot for 3 months and ankle and orthotic arch supports (worn at time of exam).  The examiner recorded diffuse left ankle pain with exam limited secondary to pain.  At the time of the NARSUM dated 4 April 2007, the CI reported continued left ankle pain aggravated by all activities and interfering with sleep.  Exam noted a normal appearing ankle with normal foot sensation.  There was tenderness and active dorsiflexion was “limited to less than 10 degrees” with ankle eversion “very limited” and no ligamentous instability.  Formal PT ROMs are as summarized in the chart above.  

At the VA Compensation and Pension (C&P) examination on 8 September 2007 (not available but exam information included in VARD dated 20 February 2008), performed approximately a month after separation, the CI reported that she experienced pain with motion (no additional loss of motion with repetitive use), fatigue, weakness and lack of endurance.  Physical exam showed an abnormal gait (she walked slowly with a limp).  ROM was limited due to pain as summarized in the chart above.  The CI was not using an assistive device.  There was no, swelling, effusion, crepitus, or ligamentous instability noted.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB (Administrative Correction) rated the left ankle condition 10% (coded 5099-5003, analogous to degenerative arthritis), citing no mechanical limitation of motion, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left ankle condition 10% (coded 5099-5271, limited motion of the ankle), citing moderate limitation of motion. The Board agreed that the ROM examinations proximate to separation detailed above were consistent with either painful motion (IAW VASRD §4.59) or a moderate limitation of motion for the 10% rating under either the VA coding option 5271 or the PEB coding option as analogous to 5003.  All Board members agreed the higher rating of 20% was not supported as there was not marked limited ROM of the ankle.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  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 left ankle condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the CI’s contended conditions (migraine headaches, anemia, irregular periods, hearing loss, functional heart murmur, insomnia, wheezing after exertion, vision impairment, occasional wrist pain, occasional chest pain and elevated cholesterol) 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.  None of the contended conditions were profiled or implicated in the commander’s statement and 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 at separation.  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 any of the contended conditions and so no additional disability ratings were recommended.  

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended 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 20140304, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
SAMR-RB

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160007273
(PD201401183)

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