RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01894
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140701
SEPARATION DATE:  20060217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (3P031/Security Forces Apprentice) medically separated for chronic right ankle pain.  The right ankle condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued an L4 profile and referred for a Medical Evaluation Board (MEB).  “Chronic right ankle pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic right ankle pain” as unfitting, rated 10%, referencing application of the VA Schedule for Rating Disabilities (VASRD).  “Overweight” was listed as a Category III condition.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right ankle condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  “Overweight” is a condition not constituting a physical disability IAW DODI 1332.38, Enclosure 5.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.  

RATING COMPARISON:

Service IPEB – Dated 20051213	VA - (3.5 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5299-5271	10%	Right Ankle Sprain	5299-5271	10%	20060531	
Overweight	Cat III - Not Compensable	No VA Entry	
Other x 0 (Not is Scope)	Other x 1	20060531	
Rating:  10%	Combined Rating:  10%	
Derived from VA Rating Decision (VARD) dated 20060707 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Ankle Pain.  The narrative summary noted a right ankle sprain in February 2004 that continued to be symptomatic despite splinting, profile restriction and physical therapy.  Plain X-rays were normal and magnetic resonance imaging indicated swelling without any other abnormality.  Bone scan performed in October 2004 documented non-specific bilateral foot stress reactions and shin splints.  Medications (Mobic and Pamelor) decreased symptoms and allowed return to running.  However, the CI re-sprained her right ankle in September 2005 (X-ray documented swelling only), the CI required another profile restriction and subsequent referral to MEB.

The MEB physical exam performed 3.5 months prior to separation noted a normal appearing right ankle with no tenderness and “full active range of motion.”  Gait was normal and sensory, motor and reflex exams were normal.  The examiner opined that the CI was “continually prone to recurrent right ankle sprains, right dorsal foot tendonitis and bilateral shin splints whenever attempting to run.”  The final diagnosis was chronic right ankle pain.

At the VA Compensation and Pension exam performed 3.5 months after separation, the CI reported the same right ankle injury history and was on continued medications.  Symptoms included continual pain with increases up to nine of ten with episodic swelling, stiffness and feeling of weakness and flare-ups.  She stated that the ankle had locked and given way “a couple of times” and seemed to roll easily.  She had a brace that she used at times.  On exam, the ankle appeared normal with active range-of-motion of 10 degrees dorsiflexion (20 degrees normal) and plantar flexion to 50 degrees (45 degrees normal), with painful motion noted.  There was generalized ankle tenderness without any focal tenderness.  There was no laxity, weakness or muscle atrophy noted.  Gait was normal including walking on heels and toes with repetitive toe raises.  The VA rated this exam at 10% for moderate limitation of dorsiflexion.

VA records indicated the CI’s ankle continued to be symptomatic with right ankle diagnoses of capulosynovitis and tibiotalar arthropathy that did not respond to conservative treatment.  The CI underwent right ankle arthroscopic surgery in July 2007 (17 months after separation) to remove infolded tissue (with a temporary 100% VA rating effective on 10 July 2007) with return to a 10% rating effective September 2007.  Later exam and VA rating in 2009 indicated a continued 10% rating with changed disability code to 5271-5020 (synovitis) since there was no longer pain-limited motion for rating under code 5271.

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the right ankle condition at 10% using coding analogous to 5271 (ankle, limited motion), mild.  The Board deliberated if any coding schema for the ankle would warrant higher than the 10% rating; however, there was insufficient evidence of marked limitation of ankle motion to warrant higher 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 right ankle condition.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

Contended PEB Condition (Overweight).  The Board’s main charge is to assess the fairness of the PEB’s determination that the overweight condition was not compensable.  “Overweight” is a condition not constituting a physical disability IAW DODI 1332.38, Enclosure 5., and the Board agreed with the PEB adjudication of Category III (not separately unfitting and not compensable or ratable).  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 Category III determination for the contended overweight condition and so no additional disability ratings are recommended.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended overweight condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  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 20140501, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-01894.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

	
XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings