RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2014-01576  
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Motor Transport Operator) medically separated for right leg pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right leg pain, status post intramedullary (IM) rod placement for closed tibia/fibular fracture” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right leg pain, post fracture of tibia and fibula” as unfitting, rated 0%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI elaborated no specific contention in his application.  

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:

IPEB – Dated 20040426	VA* - ~10 Months Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Leg Pain, Post Fracture of Tibia and Fibula	5099-5003	0%	Residuals, Fracture Right Tibia and Fibula with Limitation of Motion; Right Knee and Ankle	5262	20%	20050512	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7	
RATING:  0%		
*Derived from VA Rating Decision (VARD) dated 20050901 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Right Leg Condition.  In August 2003, a large truck tire fell on the CI’s right leg causing a distal fracture of his tibia and fibula.  On 19 August, he was surgically treated with a rod placement across the fracture site.  Post-operatively, the CI did well with regaining mobility, but pain continued around his right knee and ankle.  He was permanently profiled in March 2004 with a diagnosis of “right leg pain after fracture” and referred to a MEB.  At the MEB narrative summary examination on 19 March 2004, 5 months prior to separation, the CI’s chief complaint was listed as "My right leg, knee, and ankle bothers me with any type of activity."  The physical examination (PE) revealed decreased right knee and ankle range-of-motion (ROM) with painful motion in the knee.  The final diagnosis remained “right leg pain s/p rod placement.”  

At the VA Compensation and Pension (C&P) examination on 12 May 2005, 9 months after separation, the CI reported occasional right leg pain (just below the knee and at the ankle) described as dull and aching.  He denied knee swelling, grinding, popping, or give-way.  He endorsed the inability to hop and or jump, but also had “no difficulty walking, no difficulty standing, and can run or jog up to 1-mile before experiencing pain,” “Stairs are not a problem.”  He maintained the ability to perform as a security attendant being on his feet “50% of the time.”  The examiner noted the following at the examination:

The pains just above the ankle and just below the knee are considered pains related to the rod and not to the joints themselves.  He does not have anything that would be considered flare-ups of the leg itself, knee or ankle area.  He uses no assistive devices.

The VA’s PE revealed decreased ROM and tenderness about the right knee.  There was no painful motion, atrophy, instability, or crepitus present with respect to the right knee.  The right ankle also revealed decreased ROM.  The diagnosis was detailed as follows:

‘Right tibial and fibular fracture, now s/p tibial IM rod.  Chronic leg pain as described.  There is no direct knee involvement or knee disease; there is right knee restriction of motion secondary to pain related to anchoring of the IM rod.  There is no right ankle joint disease; there is restriction of ankle movement on the same basis as the knee that is related to anchoring of the IM rod.’

The goniometric 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.

Right Knee ROM
(Degrees)	MEB ~5 Mo. Pre-Sep
(20040414) 	VA C&P ~ 9 Mo. Post-Sep
(20050512) 	
Flexion (140 Normal)	95	94	
Extension (0 Normal)	0	0	
Comment	painful motion 	tenderness 	
§4.71a Rating	10%	0%-10%	

Right Ankle ROM
(Degrees)	MEB ~5 Mo. Pre-Sep
(20040414) 	VA C&P ~9 Mo. Post-Sep
(20050512) 	
Dorsiflexion (20 Normal)	5	5	
Plantar Flexion (45)	45	20	
Comment	-	-	
§4.71a Rating	10%	10%-20%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating analogous to 5003 (degenerative arthritis) cited “rated for pain” and addressed the condition as right leg pain.  The VA’s 20% rating was under the primary code 5262 (impairment of tibia and fibula) for “moderate” knee or ankle disability.  The Board members first deliberated and agreed that the diagnostic description of right leg pain was most accurate and not two independent medical conditions consisting of knee pathology as well as ankle pathology.  Both the MEB and the VA clearly spelled out that the ends of the surgically placed rod were the anatomic areas of persistent pain pursuant to the overall leg condition.  Therefore, both the knee and ankle are considered for PE findings, but not separately considered as primary diagnoses in this case.  Considering the lower extremity fracture site, all Board members agreed that VASRD code 5262 accurately described the condition and that the evidence supported an impairment level no greater than “slight” in reference to knee or ankle disability.  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 leg condition.

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 AR 635-40 DoDI 1332.39 for rating the leg was operant in this case and the condition was adjudicated independently of that policy/instruction by this Board.  In the matter of the right leg condition, the Board unanimously recommends a disability rating of 10%, coded 5262 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

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

CONDITION	VASRD CODE	RATING	
Right Leg Pain, Post Fracture of Tibia and Fibula 	5262	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140326, with attachments
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, AR20160000252 (PD201401576)

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 10% 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:

CF: 
(  ) DoD PDBR
(  ) DVA