RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03299
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061004

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Automated Logistic Supply Specialist, medically separated for “chronic ankle pain, diagnosed as left Achilles tendonitis,” with disability rating of 20%.  

CI CONTENTION: The applicant requests consideration of 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 - 20060814	VARD - 20070131	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Achilles Tendonitis	5271	20%	Left Achilles Tendonitis	5271	20%	20070109	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Ankle.  The service treatment record (STR) corroborated the history in the narrative summary (NARSUM) of an onset of left ankle pain in November 2005 (11 months prior to separation, 4 months after enlistment).  The NARSUM related an “injury” while running, although this is not corroborated elsewhere in the STR or VA evidence.  The CI was unable to comfortably bear weight and was graduated from crutches to a brace.  Imaging (X-ray and MRI) was normal; orthopedics diagnosed Achilles tendonitis (no surgical indications); and, there was minimal improvement with physical therapy (PT) and conservative measures.  There were no outpatient STR entries commenting on range of motion (ROM) limitations.  There was no STR evidence for joint instability or impingement, malalignment, or periods of incapacitation.

The NARSUM was conducted 28 June 2006 (3 months prior to separation) and documented continued use of a brace, listing functional limitations with running and various general soldiering requirements.  The NARSUM physical examination recorded an antalgic gait, “mild to moderate” tenderness (Achilles and lateral malleolar), and normal strength and sensation (no comment on stability testing).  The NARSUM cited PT ROM measurements for the Medical Evaluation Board (MEB) (a week earlier) which recorded dorsiflexion to minus 15 degrees (normal 20) and plantar flexion to 25 degrees (normal 45).  It is unclear if the dorsiflexion referred to de facto 5 degrees (minus 15 degrees from normal); but, based on the VA evidence which follows, it is more likely that the CI refused to dorsiflex at all due to pain (guarding the foot in 15 degrees of plantar flexion). 

A VA Compensation and Pension (C&P) examination was conducted 9 January 2007 (3 months after separation) and documented daily intermittent pain rated 6/10 prohibiting “prolonged standing without pain and stiffness,” and noted that the CI was employed as an electrician technician.  The VA physical examination recorded a “limp of left leg” requiring an ankle brace for support, the absence of edema or tenderness, and “abnormal movement and guarding ... left plantar flexion deformity.”  The VA measured ROM was dorsiflexion to 5 and plantar flexion to 15 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated under code 5271 (ankle limitation of motion) and conferred the maximum rating of 20% for “marked” limitation.  The MEB PT and VA C&P evidence suggests that the CI guarded the ankle in dorsiflexion, but ankylosis (a frozen joint) clearly was not present; and, the Board noted that even if functional ankylosis at minus 15 degrees (PT evidence) were conceded for analogous rating under 5270 (ankylosis), the VASRD §4.71a rating would still be 20%.  There are no other applicable codes available under §4.71a, and there were no fracture complications for analogous rating under 5262 (tibia and fibula, impairment of).  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 of the left ankle condition.

BOARD FINDINGS:  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. 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

SAMR-RB						

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

14 SEP 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20160007971 (PD201403299)

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