RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03079
BRANCH OF SERVICE:  Army 	                      SEPARATION DATE:  20061214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard, E2, Light Wheel Vehicle Mechanic, medically separated for “bilateral ankle pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI requested that the Board Review all of his 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 – Dated 20061129	VARD - 20070507	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Ankle Pain…	5099-5003	0%	Residuals of a Left Ankle Stress Fracture 	5099-5010	NSC	20070321	
			Residuals of a Right Ankle Stress Fracture 	5099-5010	NSC		
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Ankle Pain.  The CI developed bilateral ankle/feet pain while in basic military training in April 2006.  A bone scan revealed stress fractures in both lower extremities (right ankle/hind-foot and left mid-foot [metatarsal]).  He received non-surgical treatment to include casting of the right leg which consistently was more symptomatic than the left foot.  He was permanently profiled in October 2006 with a diagnosis of “overuse of ankles.”  He underwent a Medical Evaluation Board (MEB) on 23 October 2006.  At the 27 September 2006 MEB narrative summary (NARSUM) examination (3 months prior to separation) the CI’s chief complaint was “painful ankles, right greater than left.”  The physical examination (PE) revealed bilateral ankle decreased range of motion (ROM).  There was no evidence of ankle or foot redness or swelling.  Distal neurovascular status was intact.  His pain intensity was assessed as “slight” and “occasional.”  A clinical encounter 2 weeks after separation noted normal ankle ROM bilaterally.  

At the 21 March 2007 VA Compensation and Pension (C&P) examination (3 months after separation), the CI reported worsening painful symptoms.  The PE revealed a normal gait.  Ankle ROM was minimally decreased in bilateral dorsiflexion.  Plantar flexion was bilaterally normal.  There was no pain upon ankle motion.  Additionally, the VA exam, as well as the VARD noted that the CI ‘failed to report for scheduled x-rays’.  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. 

Ankle ROM
(Degrees)	MEB ~3 Mo. Pre-Sep
(20060927) 	PCC/VA ~2 weeks Post-Sep
(20061229) 	VA C&P ~3 Mo. Post-Sep
(20070321) 	
	Left	Right	Left	Right	Left	Right	
Dorsiflexion (20 Normal)	20	10	ROM normal	0-10	0-10	
Plantar Flexion (45)	30	30		0-45	0-45	
Comment	-	-	-	-	-	-	
§4.71a Rating	#%	#%	#%	#%	#%	#%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral condition under analogous VASRD code 5099-5003, and invoked the US Army Physical Disability Agency pain policy as the basis for its 0% rating.  The VA separately coded each ankle under VASRD 5099-5010 (traumatic arthritis) and rated as not service connected (NSC) citing “failure to show that this disability has been clinically diagnosed.”  The Board first considered if the combined bilateral ankle rating, as per the PEB approach, was most appropriate in considering separate fitness assessments.  The clinical evidence consistently reflected that the right ankle/foot was associated with more impairment than the left and the disparity was such that the question was raised of whether the left ankle/foot was reasonably justified as separately unfitting.  

Although it remained speculative to conclude that the disability confined to the left foot would have rendered the CI incapable of performing within his military specialty, Board member consensus was that it was reasonable to surmise that the overall effect of both painful ankles/feet was what rendered him unfit and unable to perform military duties.  Although the radiographic evidence indicated stress fractures in both ankles/feet, his functional ability near the time of service separation indicated minimal impairment to either ankle/foot noting normal ROM without demonstration of painful motion.  In this case, the bilateral radiographic evidence does support a single 5003 based rating for “2 or more major joints.”  After due deliberation in consideration of the totality of the evidence, the Board concluded that there was no VASRD basis to recommend a higher rating than the 0% conferred by the PEB while maintaining the bundled bilateral ankle/feet condition.

BOARD FINDINGS:  In the matter of the bilateral 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.   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 20140514, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160007958 (PD201403079)

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