RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02102
BRANCH OF SERVICE:  Army	BOARD DATE:  20150116
SEPARATION DATE:  20070328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Combat Engineer Trainee) medically separated for a chronic left ankle pain condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty but was authorized to perform an alternate physical fitness test.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The chronic left ankle pain condition, characterized as “left ankle stress fracture” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic left ankle pain” as unfitting, rated 0%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.” [sic]

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 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 20070315	VA - (11 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5099-5022	0%	Residuals Left Ankle Stress Fracture	5271	10%	20080207	
Other x 0 (Not In Scope)	Other x 1	
Combined:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20080418 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Left Ankle Pain Condition.  The CI sustained an inversion injury to his left ankle during basic training in 2006.  Routine X-rays were normal.  A magnetic resonance imaging of the left ankle, obtained for continued pain, revealed stress changes of the ankle.  This was treated with splinting and casting with apparent radiographic healing.  Nevertheless, a chronic foot pain condition developed.  On physical therapy evaluation on 7 February 2007, for the MEB, the CI was able to fully transfer from supine, to sit to stand, and fully flex and rotate the trunk with a blank facial expression.  He did report pain with all left foot motions.  A summary of this evaluation is in the chart below.  The MEB/narrative summary (NARSUM) evaluation performed on 12 January 2007, 2 months prior to separation, referenced the above physical therapy evaluation in its content.  

At the VA Compensation and Pension exam, performed 11 months after separation by a general physician’s assistant (PA), the CI reported pain, stiffness and swelling, but that the ankle condition had no impact on his full employment or normal daily activities.  He reported using a treadmill once a week, lifting weights three times a week and daily use of a “Bow flex” devise for exercise without expressed difficulty.  He noted being on no treatment for the condition.  On physical examination, the gait was normal.  No ankle swelling was present.  Motor, sensory and reflex exams in both lower extremities were normal.  Range-of-motion (ROM) findings on this examination are summarized below.  Recent routine X-rays of the ankle were normal.  

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.

Left Ankle ROM
(Degrees)	MEB ~2 Mo. Pre-Sep
(20070207) 	VA C&P ~11 Mo. Post-Sep
(20080207) 	
Dorsiflexion (20 Normal)	20	0	
Plantar Flexion (45)	50	45	
Comment	Inversion and eversion  wnl, Pt reported pain with each motion.	Gait wnl; Pain in all motions. No DeLuca	
	
The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, code 5099-5022 (Periostitis) citing full ROM with some ankle tenderness.  The VA rated 10%, code 5271 (Ankle-limitation of motion/moderate) for limitation of ankle dorsiflexion.  A higher rating of 20% under this code requires the condition to be ‘marked’.  The Board noted the differences between the NARSUM and VA ROM findings for the ankle ROM and gave higher probative value to the NARSUM findings as it was goniometric, complete and performed by a physical.  The Board agreed that the evidence in record supported the left ankle condition to be “mild” given the CI’s ability to transfer easily from sitting to standing without pain, to have a normal gait, normal ROM, to work out once a week on a treadmill, and the report that the ankle condition had no impact on work or daily activities.  The Board agreed that the CI had some pain on motion on exams proximate to separation and considered a rating for painful motion IAW §4.59.  The Board agreed that the condition was “mild” and did not rise to the level of 10% given the findings discussed above.  The Board, thus, recommended a rating of 0% for painful motion IAW §4.31 (0% rating).  The Board considered a rating under codes 5271 (limitation of motion), 5284 (foot injury), and 5283 (tarsal bones, malunion), but was unable to do so as the 10% rating under these codes requires the condition to be “moderate.”  The Board found no other appropriate codes for consideration and no pathway to a rating higher than 0% for the ankle condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change in the PEB adjudication.  

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 left ankle condition condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20140423, 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, AR20150010480 (PD201402102)

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:

Encl		     XXXXXXXXXXXXXXX							     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA