RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03732
BRANCH OF SERVICE:  Army 	Seperation date:  20071110  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Motor Transport Operator) medically separated for chronic right ankle pain.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent P3L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic right ankle pain status post two lateral ankle stabilization procedures” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (diabetes mellitus, hypertriglyceridemia and history of laparoscopic cholecystectomy) for PEB adjudication.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic right ankle pain…” as unfitting, rated 0%.  The remaining conditions were determined to be not unfitting.  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 20070809	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5024	0%	Residuals, Right Ankle Surgery	5010-5271	10%	20080108	
Diabetes Mellitus 	Not Unfitting	Diabetes Mellitus, Type II	7913	20%	20080108	
History of Laparoscopic Cholecystectomy	Not Unfitting	Scars…Gall Bladder Removal	7318-7802	0%	20080108	
Hypertriglyceridemia	Not Unfitting	No VA Placement	
Other x 0 (Not In Scope)	Other x 9	
RATING:  0%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20080502 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  The narrative summary and treatment record noted the CI had an initial right ankle tendon injury in training with surgical repair in October 2005 (modified Brostrom procedure) and an additional tendon repair surgery in November 2006 (11 months prior to separation).  At the MEB exam, the CI reported daily 7/10 ankle pain (sometimes up to 10/10) with numbness and tingling after sitting for 10 minutes, swelling if standing for 20-30 minutes, and pain if walking 50 feet.  The MEB physical exam, performed 4 months before separation, noted ankle range-of-motion (ROM) of 40 degrees for dorsiflexion (normal 20) and plantar flexion (normal 45); there was tenderness over the right lateral ankle.  The examiner also referenced a podiatry exam where the CI complained of increased pain with transition to weight bearing and rotation movement of the ankle; this exam also documented swelling and tenderness of the lateral malleolus.  The DD Form 2808, Report of Medical Examination, documented pain with right ankle motion and tenderness to palpation laterally.  X-ray and MRI imaging of the ankle indicated post-surgical changes without acute findings.  

At the VA Compensation and Pension (C&P) exam performed 2 months after separation, the CI reported that weight bearing activities were painful.  The examiner documented a normal gait with full ROM with dorsiflexion and plantar flexion and pain along the lateral aspect of the ankle.  There was no laxity or instability.  There was tenderness along the lateral ligaments with a well healed scar.  There were no motor or sensory abnormalities noted.  

The Board directed its attention to its rating recommendation based on the above evidence.  There was no ankle instability and ankle ROM was either normal, or at most, slightly limited on exams.  The critical issue for rating in this case was whether sufficient objective evidence existed of painful motion (IAW VASRD §4.59) and/or functional loss (IAW VASRD §4.40) to warrant a 10% rating IAW VASRD criteria.  The preponderance of the record indicated increased pain with weight bearing activities and the DD Form 2808 documented painful motion.  The Board adjudged that there was sufficient objective evidence for a 10% rating IAW VASRD §4.59.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right ankle condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that diabetes mellitus, hypertriglyceridemia, and history of laparoscopic cholecystectomy were 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.  Hypertriglyceridemia is an abnormal lab condition and not a compensable disability condition.  The history of cholecystectomy had no residuals and there was no indication that any abdominal condition interfered with performance of duty.  

The diabetes mellitus condition was profiled as P3, mentioned in the commander’s statement, and was judged to fail retention standards.  The CI was diagnosed with diabetes mellitus in January 2006 and was taking oral medications for control.  Her glucose control in May 2007 was good with a normal fasting blood sugar and hemoglobin A1C (indicating longer duration glucose control).  Treatment notes indicated a diagnosis of “Diabetes Type II, uncomplicated, controlled.”  At the VA exam, the CI reported that she ran out of medication in November 2007 (time of separation) and had symptoms of increased thirst, increased urination, and increased appetite.  The CI reported occasional dizziness with lightheaded feelings and denied visual symptoms, or episodes of ketoacidosis, hypoglycemia, or hospitalization for diabetes.  There were no restrictions on activities, no peripheral neuropathy and no diabetic retinopathy.  VA records indicated that the CI was hospitalized for ketoacidosis in June 2008 (7 months after separation) with addition of insulin to her oral medications for diabetes treatment.  

All contended conditions were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions 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 any of the contended conditions and so no additional disability ratings are recommended.  

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.  In the matter of the right ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5024 IAW VASRD §4.71a.  In the matter of the contended diabetes mellitus, hypertriglyceridemia, and history of laparoscopic cholecystectomy conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Right Ankle Pain 	5099-5024	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140806, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX, AR20160003069 (PD201403732)

1. 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,
accept the Board's recommendation to modify the individual's disability rating to 10%
without re-characterization of the individual's separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA