RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03513
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080509

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-2, Healthcare Specialist, medically separated by the Informal Physical Evaluation Board (IPEB) for “right ankle pain” with a disability rating of 10%. 

CI CONTENTION:  The applicant has asked for consideration of all conditions in her application.  The applicant’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 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 20080318	VARD - 20090429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain…	5271	10%	Chronic Right Ankle Anterior Talofibular Ligament Tear	5271	10%	20090318	
Plantar Fasciitis	Not Unfitting	Bilateral Plantar Fasciitis	5276	NSC	20090318	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 6 (equals SC, NSC & deferred)	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Ankle Pain Condition.  The record showed that the CI injured her right ankle on a road march in August 2007.  The first record in evidence for review is an orthopedic appointment dated 11 January 2008.  She reported ongoing pain aggravated by activity.  On examination, she was noted to have tenderness over the anterior talo-fibular ligament (ATF), but no laxity.  At a magnetic resonance image taken in December 2007, she had been noted to have a chronic tear of the right ATF.  She was referred to an Medical Evaluation Board (MEB) as she had requested.  The narrative summary (NARSUM) was dated 17 January 2008.  It noted that she had been treated with medications and physical therapy.  She was tender to palpation at the ATF.  There was no swelling or laxity on examination.  She was also noted to have a history of plantar fasciitis which existed prior to service (EPTS).  No comment was made on either gait or the use of an assistive device.  The range-of-motion (ROM) is charted below.  At the VA Compensation and Pension (C&P) examination performed on 18 March 2009, just over 12 months after separation.  The CI reported that she used crutches at home after a long day on her feet, but no assistive device was in use at the examination and the records did not support this statement.  She worked as a sales associate.  On examination, she was shown to have a normal gait and motor function.  There was no evidence of painful motion, swelling, tenderness, weakness, or abnormal weight bearing.  She was tender to palpation, but the ankle was stable.  The ROM was painful at the end point, but there was no additional loss with repetition.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right ankle at 10%, coded 5271 (limited motion of the ankle at the moderate level).  Absent an abnormal gait and/or more restricted limitation in motion, the Board found no support for a higher 20% rating.  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 right ankle condition.  

Contended PEB Conditions.  The plantar fasciitis condition was not noted in the records until the MEB NARSUM when it was noted to be EPTS.  Regardless, it was found to meet retention standards.  The Board’s main charge is to assess the fairness of the PEB’s determination that it was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The plantar fasciitis was profiled (L3, but this also encompassed the unfitting right ankle), but not specifically 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 it 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 any of the contended plantar fasciitis condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended plantar fasciitis condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160004522 (PD201403513)

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