RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01829
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Calvary Scout, medically separated for “chronic ankle and groin pain,” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”

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 – 20030408	VARD - 20070405   	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Ankle and Groin Pain	5099-5003	10%	Residuals, Right Ankle Sprain	5299-5271	10%	20070319	
			Right Inguinal Ring Strain	7339-7338	0%		
COMBINED RATING:  10%	RATING:  30%	

ANALYSIS SUMMARY:  

Chronic Ankle Pain.  The service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a twisting (inversion) injury to the right ankle in March 2002 (3 years after entry).  A grade II ligament sprain initially affected the lateral ankle, and resulted in chronic intermittent medial malleolus pain.  Despite treatment, the ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “chronic intermittent right ankle pain” for PEB adjudication.  

During the MEB NARSUM examination in October 2002 (10 months pre-separation), the CI reported intermittent 4-6/10 pain that occurred with prolonged walking or running.  The examiner documented normal range of motion (ROM) with tenderness of the medial ankle (malleolus).  Sensation, strength, and reflex exams were normal.  Radiographs were normal.  On the MEB DD Form 2807-1 in November 2002 and DD Form 2808 in December 2002, the CI reported right ankle pain with walking, and the examiner documented pain with passive inversion and moderate ankle laxity bilaterally.  A second MEB NARSUM examination was performed in March 2003 (5 months pre-separation).  The examiner documented dorsiflexion of 10 degrees (normal 20) with discomfort, and plantar flexion of 25 degrees bilaterally.  Radiographic evaluation (MRI) reportedly documented an area of sclerosis (healing) on the lateral distal tibia, an old avulsion fracture of the medial malleolus, and no other bony defects.  

Chronic Groin Pain.  The STR and MEB NARSUM documented a right groin injury after carrying heavy equipment in June 2001 (2 years after entry).  Consultations to general surgery and urology found no surgical options.  Radiographic evaluation (ultrasound) reportedly documented “mild fascial weakness” without definite hernia.  Despite treatment, the groin condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “chronic recurrent groin pain” for PEB adjudication.  

At the MEB NARSUM examination in October 2002 (10 months pre-separation), the CI reported a constant dull (4-6/ 10) ache that worsened with running, jumping, lifting greater than 15 pounds, and multiple soldiering activities.  The examiner documented tenderness to the right of the pubic symphysis that radiated into the right testicle.  On the MEB DD Form 2808, the examiner documented a tender right inguinal canal with no evidence of hernia.  During the second MEB NARSUM examination in March 2003, the examiner documented discomfort in the groin with hip rotation.  Hip ROM was normal.  “Mild fascial weakness” was documented, with no evidence of swelling or hernia and no evidence of inguinal ring tear.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for both the chronic ankle pain and groin pain coded analogously 5099-5003 (degenerative arthritis).  The VA rated each condition individually.  The “residuals, right ankle sprain” was rated 10% and coded analogously as 5299-5271 (ankle, limitation of motion of, moderate).  The “right inguinal ring strain, claimed as right groin pain” was rated 0% and analogously coded 7339-7338 (hernia, ventral, postoperative; hernia, inguinal).

The Board first considered if “chronic ankle pain” and “right groin pain” were reasonably justified as separately unfitting as established above.  In this case, both conditions were considered to fail retention standards; both were implicated by the NARSUM and in the commander’s statement; and, both were profiled.  Members agreed that the evidence of the record reasonably supported that each condition was separately unfitting.  

Chronic Ankle Pain.  The MEB examination supported of a 10% rating based on functional loss (§4.40 and §4.45) due to painful motion (§4.59) and ligamentous laxity.  The NARSUM examination documented a 50% reduction in ROM that could be described as a moderate limitation of ankle motion (5299-5271), and supportive of a 10% rating.  There were no measurements in evidence to support a higher rating for marked limitation of motion.  The Board also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7), however, all Board members agreed that the impairment did not more nearly approximate “moderately severe” to support a higher rating.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than a 10% rating.  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 “chronic ankle pain” condition.  

Chronic Groin Pain.  There was no STR evidence of operative intervention for a rating of 10% or higher using the VASRD coding for inguinal (7338) or ventral postoperative (7339) hernia.  There was radiographic documentation of the absence of true hernia protrusion that would support a 0% rating, coded 7338 (hernia, inguinal).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 0% for the groin condition.  

Although both conditions were judged to be separately unfitting, the combined ratings for both conditions do not yield a higher rating than the 10% adjudicated by the PEB, and, therefore provided no benefit to the CI.  

BOARD FINDINGS:  In the matter of the chronic ankle and groin pain condition and IAW VASRD §4.71a and §4.114, the Board unanimously recommends no change in the PEB adjudication.  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 20140422, 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 XXXXXXXXXXXXXXXXXXXXXXX  AR20160010651 (PD201401829)

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