RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02822
BRANCH OF SERVICE:  Army	BOARD DATE:  20150521
SEPARATION DATE:  20040405

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E-1 (Petroleum Supply Specialist Trainee) medically separated for a left ankle condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty but was authorized to perform an alternate physical fitness test (per PROFILE).  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “left ankle talus 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 “left ankle talus stress fracture” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Multiple sclerosis, ankle injury.” The applicant’s complete submission is at Exhibit A.

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:

IPEB – Dated 20040226	VA* - Based on Service Records (SR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Talus Stress Fracture	5099-5022	0%	Residuals, Non-Displaced Fracture of the Left Lateral Malleolus	5271	0%	SR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20050201 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Ankle Condition.  The narrative summary (NARSUM) noted the CI had onset of left ankle pain the second week of basic training.  Imaging documented evidence of a non-displaced fracture of the left calcaneous and stress fracture of the talus (bone scan).  Physical therapy rehabilitation did not resolve the ankle pain or allow return to training.  Physical therapy note from 16 December 2003 (4 months prior to separation) had documented left ankle stability with painful motion and range-of-motion (ROM) testing with dorsiflexion limited to 3 degrees (normal 20) and plantar flexion 25 degrees (normal 45).  The MEB physical exam (approximately 3 months prior to separation) documented a tender left ankle with good muscle strength.  Dorsiflexion was 0 degrees (normal 20) compared to 5 degrees in the opposite ankle.  There was some mild deformity of the great toe at the forefoot (hallux abductovalgus).

The record indicated that the CI failed to show for a VA Compensation and Pension (C&P) exam scheduled in January 2005 and the VARD dated 1 February 2005 granted service-connection with a 0% rating as there was no VA exam.  The CI had a C&P exam on 2 March 2005 and complained of limitations in prolonged walking and standing and a stiff left ankle with pain.  She also complained of weekly episodes of dislocation or subluxation (instability).  Exam documented a normal gait with an abnormal shoe wear pattern.  No goniometric ROM testing was in evidence, but the examiner answered “no” to the question of “is the motion of any joint limited by joint disease or injury(?).”  Radiographs documented mild medial irregularity that correlated with ligamentous injury of the ankle.  No VARD in evidence appeared to reference or rate this examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating was analogous to 5022 (periostitis) and VA coding was under 5271 (ankle limited motion).  The Board considered the criteria under those codes as well as code 5262 (tibia and fibula impairment) to arrive at a fair rating recommendation.  The Board adjudged the NARSUM exam with the most proximate physical therapy exam had the highest probative value for rating.  The record documented pain-limited ankle ROM that warranted a minimum 10% rating IAW VASRD §4.59 (painful motion).  The Board next considered if the CI had “marked” ankle limitation of motion (20% under 5271) to warrant any rating higher than 10% (“moderate” would equate to a 10% rating).  The Board majority adjudged that the evidence did not support a “marked” limitation of ankle ROM.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59 (painful motion), the Board majority recommends a disability rating of 10% for the left 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.  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, the Board majority recommends a disability rating of 10%, coded 5099-5022 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING	
Left Ankle Talus Stress Fracture	5099-5022	10%	
COMBINED	10%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140602, 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 XXXXXXXXXXXXXXXXXX, AR20160002821 (PD201402822)  

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA