RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02128
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050910

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Indirect Fire Infantryman, medically separated for “chronic pain, right ankle status post medial malleolus fracture” with a disability rating of 10%.  

CI CONTENTION:  The CI requests the Board consider all conditions.  The CI’s complete submission is at Exhibit A.

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 - 20050616	VARD - 20060228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Ankle Status Post Medial Malleolus Fracture	5099-5003	10%	Post Traumatic Changes, Osteoarthritis Right Ankle	5010	10%	20051104	
Hypertension	Not Unfitting	Hypertension	7101	0%	20051104	
Seasonal Allergic Rhinitis	Not Unfitting	Allergic Rhinitis	6522	NSC	20051104	
Hematuria, Persistent	Not Unfitting	Hematuria	7508	NSC	20051104	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Ankle Status Post Medial Malleolus Fracture.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a right ankle fracture in August 2004.  
Initial radiographic imaging revealed a non-displaced fracture of the right medial ankle.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic pain, right ankle status post medial malleolus fracture” for PEB adjudication.  At the MEB narrative summary (NARSUM) examination performed on 21 April 2005, 5 months prior to separation, the CI endorsed continued right ankle pain.  His physical examination (PE) revealed normal but painful motion of the right ankle.  Additionally, the right ankle was diffusely tender without instability.  At the VA Compensation and Pension (C&P) examination performed on 04 November 2005, 2 months after separation, the CI reported, “hurting, popping and grinding" of the right ankle.  He endorsed the inability to run, jump or play sports.  Although he describes daily pain, his condition did not interfere with activities of daily living.  His PE revealed normal but painful motion of the right ankle.  His gait was described as “steady and smooth”.  

The Board directed attention to its rating recommendation based on the above evidence.  Although using different but similar VASRD codes, both the PEB and VA rated the right ankle condition at 10% impairment.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However, there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45).  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to the PEB’s current 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.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that hypertension, seasonal allergic rhinitis (SAR), and hematuria were not unfitting.  The conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   ll were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  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’s fitness determination for the any of the three contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  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 hypertension, SAR, and hematuria conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140425, with attachments
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 XXXXXXXXXXXXXXXXXXXXX AR20160011080 (PD201402128)

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