RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02434
BRANCH OF SERVICE:  Army	BOARD DATE:  20150327
SEPARATION DATE:  20020622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Public Affairs Specialist) medically separated for an ankle condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right ankle pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right ankle pain” as unfitting, rated 10% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was told that I shouldn’t request more money/benefits until discharged, via the VA.  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 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 20020506	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5099-5003	10%	Residual, Right Ankle Injury	5299-5271	10%	20020802	
Other x 0 (Not In Scope)	Other x 4 (Not In Scope)	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20020925 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Ankle Condition.  The narrative summary notes the CI injured her right ankle during basic training in September 2001.  Initial X-rays and a bone scan noted no abnormality of the right foot or ankle.  Notes in the service treatment record (STR) indicated the CI was treated with physical therapy (PT) and she reported some decrease in her symptoms with use of crutches.  Examinations in the STR from 7 months prior to separation noted full ankle range-of-motion (ROM) with persistent tenderness of the ankle joint, but no swelling.  A repeat bone scan on 17 January 2002 was normal.  A PT note 29 January 2002, 5 months prior to separation, noted full ROM with persistent ankle tenderness, with maximal benefit attained from therapy and referred the CI to sports medicine.  At a sports medicine evaluation on 6 February 2002 the exam noted full ROM with no point tenderness, swelling, or instability.  The examiner noted the normal bone scan and X-rays and indicated there was no specific diagnosis, but ankle pain from sprains can take months to resolve.  The examiner recommended additional therapy, followed by a MEB if there was no improvement.  Despite the additional therapy the CI continued to report ankle pain.

At the MEB examination on 8 April 2002, 3 months prior to separation, the CI reported constant ankle pain.  She reported that she could walk 30 feet without crutches, 5 minutes with crutches, and that she was taking over the counter anti-inflammatory medication 3 to 4 times per day.  The MEB physical exam noted the CI was wearing an ankle brace and could walk without crutches, but with an abnormal gait favoring the right.  Ankle ROM was dorsiflexion (DF) of 20 degrees (normal 20) and plantar flexion (PF) of 50 degrees (normal 45).  Ankle strength was normal and there was no point tenderness, swelling, or instability.

At the VA Compensation and Pension (C&P) examination on 2 August 2002, a month after separation, the CI reported ankle pain, numbness, and poor circulation.  The exam noted DF of 25 degrees and PF of 35 degrees, decreased with repetition to DF of 20 degrees and PF of 30 degrees.  Strength was normal and sensation to light touch was described as “diminished about the right ankle.”  The examiner noted a magnetic resonance imaging (MRI) scan of the ankle was scheduled later in the month.  The VARD on 27 November 2002 summarized the MRI report and additional outpatient VA treatment records submitted by the CI.  The MRI noted a “small amount” of fluid in the tendon sheath of the flexor hallucis longus [flexes the great toe/assists foot flexion and inversion] as it passes behind the ankle and no bone or ligament injuries.  The impression was probable tenosynovitis.  The VARD summarized the VA outpatient treatment note on 17 September 2002, 3 months after separation, as “…you wear a brace on your right lower extremity.  Your right ankle was stiff and resisted any motion.  The ankle was not shown to be ankylosed.”  A remote C&P examination on 7 May 2009 indicated right ankle ROM of DF 10 degrees and PF 25 degrees with tenderness, but no swelling, instability, or weakness.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition 10%, coded 5099-5003 (analogous to degenerative arthritis) and cited the USAPDA pain policy.  The original VARD rated the ankle condition 10%, coded 5271 for moderate limited ankle motion.  The VARD on 27 November 2002 increased the rating to 20% for “additional limitation of motion requiring a brace.”  Members noted that the rating criteria of 5271 are subjective with a 10% rating for “moderate” limitation of motion and 20% for “marked..  At the C&P exam, there was additional loss of ankle ROM with repetition noted, but the Board opined that even the ROM after repetition was consistent with “moderate” rather than “marked” limited ankle motion.  The Board deliberated the after separation VA evidence that described the ankle as stiff and “resists any motion,” but there was no medical explanation offered in the records or suggested by the MRI for the apparent worsening of the ankle condition in the 6 week period between the C&P exam and the cited treatment visit.  Ankle ROM had been stable and consistently reported as full ROM at evaluations in the STR for 7 months prior to separation, including at the sports medicine and MEB exams and a remote C&P exam in 2009 indicated ankle ROM consistent with “moderate” decreased ankle ROM.  The Board agreed that the preponderance of the ROM evidence proximate to separation supports a 10% rating, coded as 5271.  The Board reviewed to see if a higher evaluation was achieved with any alternative coding approach.  There was no evidence of nonunion, malunion, deformity, ankylosis of the ankle or subtalar joint, or impairment of the tibia or fibula to provide a higher evaluation.  The MRI shortly after separation showed evidence of a tendon injury, without other abnormalities of the bones or ligaments noted.  However, the Board agreed coding the as 5024 (tenosynovitis) provides a maximum rating of 10% for a single joint or with the 5284 code for other foot injury also result in a 10% rating recommendation.  The Board could find no basis to recommend a higher disability rating of the ankle condition at separation than that conferred by the PEB.  Thus, the PEB’s reliance on the USAPDA pain policy for rating the ankle condition was not detrimental to achieving the highest rating and therefore, no change to the code is recommended.  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.

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 for rating the right ankle condition was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right ankle 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 20140513 w/atchs
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 XXXXXXXXXXXXXXXXXXXX, AR20150014439 (PD201402434)

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						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA