RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03705
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150619
Seperation date:  20050606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Personnel Journeyman) medically separated for arthritis of the right foot.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “right subtalar joint arthrosis due to fall” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right subtalar joint arthrosis due to fall” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The IPEB also included a Category III condition (“history of adjustment disorder”), which is not separately unfit & compensable/ratable.  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 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 20050418	VA* - (~1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Subtalar Joint Arthrosis…	5272-5299	10%	Residuals of Right Ankle Fracture	5271	0%	20050630	
History of Adjustment Disorder	Not Unfitting (Cat III)	Alcohol Dependence (In Remission) (Claimed As Adjustment Disorder With Anxiety And Depression And Mental Health Condition) 	9499-9413	NSC	20050630	
Other x 0 (Not In Scope)	Other x 9 	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20070209 (most proximate to date of separation [DOS]).
ANALYSIS SUMMARY:

Right Subtalar Joint Arthrosis…Condition.  The medical records recorded a history of chronic right ankle and foot pain secondary to a fracture to the talus after falling four stories while overseas in January 2001.  The CI’s fractured ankle was treated non-surgically (cast) and she continued to experience pain in the right foot that increased with activity.  The CI noted that she had mild pain with every step of walking, and at times she was unable to walk.  She was treated conservatively with injections, non-steroidal anti-inflammatory medication, narcotic medications, shoe orthotics, and modification of activities; however, her pain persisted.  The CI was referred to orthopedic to evaluate treatment options including surgery; however, she declined surgery.  Right ankle radiographs taken in June 2004 demonstrated sclerosis and spur formation laterally in the subtalar joint consistent with arthrosis.  There was no apparent ankle arthritis. At the MEB/narrative summary (NARSUM) examination on 3 March 2005, approximately 3 months prior to separation, the CI reported persistent foot and ankle pain since her fall.  Her pain is worse after a day of full activity.  She was working in a desk job and was not deployable due to her injury.  The CI had a recurring cycle of profiles which significantly limited her activities including physical training.  She noted that she took medications that offered limited benefit.  Physical examination recorded right subtalar joint tenderness to palpation, especially in the lateral side of the joint.  There was no evidence of neurological or vascular compromise distal to the injury and she had normal ankle motion.  Right ankle range-of-motion (ROM) recorded dorsiflexion at “approximately 10 degrees (NL=20), and plantar flexion to approximately 30 degrees” (45).  ROM of the subtalar joint noted eversion to approximately five degrees (average=5), and inversion to 10 degrees (20).  The examiner opined that her foot pain with ambulation would likely continue, and her prognosis was fair.  At the Compensation and Pension evaluation on 30 June 2005, approximately 3 weeks after separation, the CI reported daily aching, burning and sharp pains around the right ankle.  She was using a brace on an as needed basis, and was able to walk without limitations; however, noted she was not able to run due to pain.  Right ankle examination revealed tenderness at the tip of the fibula.  ROM was documented as “entirely normal” with dorsiflexion of 20 degrees and plantar flexion of 45 degrees.  Her gait was normal and the examiner noted absence of discomfort with repetitive motion.  Furthermore, ROM was not limited by pain, fatigue, weakness or lack of endurance.  It was noted that the most recent radiographs dated 23 February 2005 demonstrated no evidence of inflammatory change or arthritis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA chose different coding options for the condition.  The PEB rated the condition under the analogous 5272-5299 code (Subastragalar or tarsal joint, ankylosis of) and assigned a 10% rating (for good weight bearing position).  The VA rated the condition as “residuals of right ankle fracture” and applied code 5271 (ankle, limited motion) for a 0% rating.  A higher rating under the 5272 code requires evidence of “poor” weight bearing position that is not supported by the record.  The Board next considered the 5270 and 5271 codes; however, there was no objective evidence of ankylosis or of poor weight bearing on the ankle, and the decrease in ROM recorded at the NARSUM would not support a rating higher than 10%.  Given the record of evidence the Board could not find other applicable VARSD codes for consideration.  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 chronic right foot and ankle pain condition.

Contended PEB Condition.

History of Adjustment Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the condition of adjustment disorder (history of) 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 adjustment disorder is considered a condition not constituting a physical disability, IAW the DoDI 1332.38 which was in effect at that time, and therefore, is not subject to a rating.

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.  In the matter of the right subtalar joint arthrosis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended history of adjustment disorder condition, the Board finds this condition not a ratable or compensable disability IAW DoDI 1332.38 at the time of the CI’s separation. 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 20140716, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03705.

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.

Sincerely,

XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR