RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03155
BRANCH OF SERVICE:  Army	BOARD DATE:  20150522
SEPARATION DATE:  20041006

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-2, Motor Transport Operator, medically separated for chronic left ankle pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, his physical profile authorized him to perform two alternate aerobic Army Physical Fitness Test events.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “chronic left 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 “chronic left ankle pain” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “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 20040820	VA* - (~1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5099-5003	10%	Sprain, Left ankle	5299-5271	0%	20041030	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20041207 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Left Ankle Pain Condition.  The CI first presented with left foot and ankle pain on 2 December 2003 while in basic training.  He was treated with medications and a brace, but his symptoms persisted.  An X-ray on 9 December 2003 was normal.  He continued duty limitations and was also treated in physical therapy with persistent pain.  On 10 February 2004, he was evaluated in orthopedics and had an unstable ankle on examination.  He was placed in a cast for 3 weeks without resolution of his pain or ligamentous instability.  Repeat X-rays on both 24 March and 19 May 2004 were normal.  A bone scan on 2 June 2004 noted changes consistent with either a stress reaction or a healing ankle fracture; the stress reaction was determined to be the more likely diagnosis.  The narrative summary was dated 26 July 2004, just over 2 months prior to separation.  The CI had pain to deep palpation of the ankle ligaments and slight laxity on one test (anterior drawers) which was less than previously noted.  A slightly antalgic gait was present (abnormal secondary to pain avoidance).  However, the range-of-motion (ROM) was intact, albeit painful, and the neurological examination normal without atrophy.  At the VA Compensation and Pension examination performed on 30 October 2004, less than a month after separation, the CI reported that the ankle caused no incapacitation, time lost from work, and that he did not use an assistive device.  He was noted to be in no acute distress and to have a normal gait.  The ankle was normal to examination including ROM.  Instability was not documented.  X-rays were normal.  The ankle condition was determined to have resolved and no pathology was present.  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.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition at 10% using the code 5099-5003 (analogous to degenerative arthritis) and citing the pain policy.  The VA rated the ankle at 0% using the code 5299-5271 (limited motion of the ankle).  The Board found no route to a rating higher than the 10% rating adjudicated by the PEB.  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 fitness determination 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the left ankle was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the left 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 20140626, 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 XXXXXXXXXX, AR20160003770 (PD201403155)

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