RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03208
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E5, Security Forces Craftsman, medically separated for “chronic ankle pain secondary to left ankle avulsion fracture” with a disability rating of 20%.

CI CONTENTION:  “Please 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 – 20040914	VARD – 20060222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Ankle Pain Secondary to Left Ankle Avulsion Fracture	5271	20%	Left Ankle Sprain and Avulsion Fracture Status Post Synovectomy	5271	10%	20050423	
Focal Spasmodic Cervical Dystonia	Category II	Cervical Spondylosis with Focal Spasmodic Dystonia	5242	0%	20050423	
Tobacco Abuse	Category III	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Ankle Pain Secondary to Left Ankle Avulsion Fracture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left ankle surgery in March 2004 for an avulsion (forcible detachment of a bodily structure) fracture.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left ankle pain” for PEB adjudication.

The range of motion (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.

Left Ankle ROM
(Degrees)	MEB ~10 Mos. Pre-Sep	Ortho ~4 Mos. 
Pre-Sep	PT ~3 Mos. 
Pre-Sep	VA C&P ~6 Mos. Post-Sep	
Dorsiflexion (20 Normal)	“normal”	15	“Marked”	15	
Plantar Flexion (45)	“normal	-	-	30	
Comments	Tenderness and slight weakness with eversion	Tenderness and weakness with eversion	Painful motion	Painful motion and instability	
§4.71a Rating	10%	10%	20%	10%	

The 1 December 2003 MEB NARSUM, 10 months prior to separation, noted episodes of “ankle giving out.”  The MEB physical examination noted “tenderness at the tibiotalar joint” and “slight weakness with resisted eversion of the left ankle.”  The CI had normal ROM, motor strength, and gait.  At the 15 June 2004 orthopedic clinic appointment, 4 months prior to separation, the CI reported increased ankle pain from activities associated with his military duties.  On examination the CI’s dorsiflexion was decreased as indicated in the chart above.  The examiner did not mention if the CI had painful motion, but did report “generalized weakness with eversion.”  There was no crepitus (grating sensation or sound) with ROM testing.  The CI had tenderness to palpation of his left ankle, but there was no swelling or instability.  The 19 July 2004 physical therapy (PT) progress report summary indicated that the CI had “marked limitation” of motion of the left ankle, “especially dorsiflexion.”  He also had decreased strength in his left foot; “severe pain on movement, weight bearing, and palpation; swelling; and was “limited in all weight bearing activities.”  At the 23 April 2005 VA Compensation and Pension (C&P) examination, 6 months after separation, the examiner recorded that the CI had “disabling pain in his [left] foot.” Physical examination showed decreased left ankle ROM as indicated in the chart above with pain on eversion.  The CI also had “a slight amount of instability in the anterior posterior direction” and “pain to palpation over the lateral malleolus.” 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 20%, coded 5271 (limited motion of ankle), citing marked limitation of motion.  The VA rated the left ankle condition 10%, coded 5271, citing moderate limited motion of ankle.  The Board considered rating under the diagnostic code 5271, limited ankle motion.  The Board noted that the PEB assigned the maximum rating (20%) available under the diagnostic code 5271.  The Board considered whether a higher rating was supported under other diagnostic code options.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 20% rating adjudicated by the PEB.  The Board also considered whether rating under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7), however all Board members agreed that the severe level (30%) was not supported.  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 left ankle condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that focal spasmodic dystonia of the neck region, or tobacco abuse, were not unfitting.  Tobacco abuse is a condition that does not constitute a physical disability.  The Board therefore has no reasonable basis for recommending this condition as additionally unfitting for separation rating.  The contended neck condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  It was reviewed and considered by the Board.  There was no performance based evidence from the record that this condition 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 fitness determination for the contended neck condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the left ankle condition, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended neck condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20140620, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03208.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Attachment:
Record of Proceedings