RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01364
BRANCH OF SERVICE:  Army	BOARD DATE:  20150311
SEPARATION DATE:  20060326

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Automated Logistics Specialist) medically separated for a chronic right ankle pain condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right ankle condition, characterized as “chronic right ankle pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  Ten other conditions (low back pain, bilateral plantar fasciitis, bilateral knee pain, bilateral tinnitus, left wrist pain, recurrent urolithiasis, mild asthma, left hip pain, mild bilateral sensorineural hearing loss and adjustment disorder, NOS) were submitted by the MEB as meeting retention standards.  The Informal PEB adjudicated “chronic right ankle pain” as unfitting, rated 10%, citing criteria of the US Army Physical Disability Agency (USAPDA) pain policy.  The PEB adjudicated the remaining conditions as not unfitting and therefore not ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Changes as per the Wounded War Act signed into law January 28, 2008.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the 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/Naval 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 IPEB – Dated 20060110	VA - (3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5099-5003	10%	Right Ankle Sprain and Arthritis	5271	20%	20060620	
Other x 10 (Not In Scope)	Other x 10	
Combined:  10%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20060720 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Ankle Condition.  The narrative summary notes the CI injured his right ankle when he twisted it while deployed in 2002.  It was treated conservatively in theater and the CI completed the deployment with his unit.  When he returned from deployment the ankle continued to hurt.  A podiatrist serially injected the right ankle for diagnostic purposes and found the pain was 90% relieved for several hours with injection of the subtalar (ST) joint.  The CI continued to report deep ankle pain and frequent rolling of the ankle and magnetic resonance imaging was reported as showing a bone bruise of the talar bone and stress X-rays of the ankle were within normal.  The podiatrist noted functional instability and the CI were referred to physical therapy for strengthening.  Right ankle arthroscopy was performed in November 2003 with debridement of tissue and cartilage.  At follow-up podiatry visits the CI reported 0/10 pain at rest, but increased to 5/10 with the foot down and that he limited periods of weight bearing to avoid swelling.  The ankle pain continued and the CI was unable to perform running or marching and a MEB was initiated.  The MEB orthopedic consult on 2 November 2005 noted that it was unclear what had been done at the arthroscopy performed at another military treatment facility and the CI reported that he was told the next level of surgery for the ankle would be a fusion.  On exam the orthopedic specialist noted “markedly decreased dorsiflexion” described as “to neutral” (normal 20 degrees) with plantar fasciitis (PF) of 30 degrees (normal 45), decreased ST ankle motion, and painful motion.  Right ankle X-rays reportedly were normal and showed no surgical hardware.  At the MEB Podiatry consult on 16 November 2005 the CI reported pain of the right foot and ankle increased by weight bearing.  The exam noted “-25 [minus 25] degrees DF, PF of 20 degrees, and limited ST joint motion, without crepitus.”  There was no evidence of arthritis on X-rays.

At the MEB examination on 23 November 2005, 4 months prior to separation, the CI reported constant right ankle pain worsened by weight bearing activities or twisting of the ankle treated with pain medication and limping due to ankle pain.  The MEB physical exam noted range-of-motion (ROM) as dorsiflexion (DF) of 11, 11, and 11 degrees limited by pain and PF of 22, 20, and 19 degrees.  There was no ankle tenderness or swelling, and strength, sensation, and pulses were normal.

At the VA Compensation and Pension (C&P) examination on 20 June 2006, 3 months after separation, the CI reported right ankle pain with flare-ups with activity.  He denied using a crutch, cane or brace.  The exam noted a normal posture and gait but elsewhere noted the CI walked with a limp.  Ankle ROM was DF of 0 degrees and PF of 25 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition 10%, coded 5099-5003 (analogous to degenerative arthritis) and noted “rated for pain, moderate and occasional.”  The VA rated the ankle condition 20%, coded 5271 (limited ankle motion).  The Board considered the ROM evidence at the four examinations reviewed above, with essentially no DF noted at three exams.  At the MEB exam better, but still moderately limited DF was noted, which was inconsistent with the orthopedic and podiatry exams before it and the C&P after it.  Member consensus was that MEB exam may have reflected a “good day” for the CI’s ankle but that the preponderance of the ROM evidence supports the 20% rating IAW with VASRD §4.3 (reasonable doubt) and §4.7 (higher of two evaluations).  The Board reviewed to see if a higher evaluation was achieved with any other applicable code, but there was no evidence of nonunion, malunion, deformity, ankylosis of the ankle or subtalar joint, or impairment of the tibia or fibula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 and §4.7 the Board recommends a disability rating of 20% for the right ankle condition, coded 5271.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy for rating the ankle condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right ankle condition, the Board unanimously recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Right Ankle Pain Condition	5271	20%	
COMBINED	20%	

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

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150013442 (PD201401364)

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,   I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization 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:

Encl		XXXXXXXXXXXXXXX
			Deputy Assistant Secretary of the Army
			     (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA