RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03955
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic left ankle pain” and “chronic left foot pain,” rated 10% and 0%, respectively, with a combined 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 based upon a 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 - 20090102	VARD - 20090502	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5099-5003	10%	Left Anterior Tibiofibular Ligament of the Left Ankle with Instability	5299-5271	10%	STR	
Chronic Left Foot Pain	5010	10%	Arthritic Posttraumatic Changes of the First Proximal Phalanx with Mild Pes Planus, Left Foot	5299-5284	10%	STR	
Right Knee Patellofemoral Pain Syndrome	Not Unfitting	Right Knee Patellofemoral Syndrome	5099-5024	NSC	STR	
Right Ankle Pain	Not Unfitting	Right Ankle Pain	5299-5271	NSC	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in April 2008 after falling 30 feet on an obstacle course during Basic Training.  The CI reported immediate left ankle pain and swelling and radiographic (X-rays) studies were negative for acute fracture.  The CI was evaluated by a podiatrist and diagnosed with a grade III (ligament tear) ankle sprain and was casted.  Following cast removal the CI was treated by physical therapy (PT) and occupational therapy (OT) without resolution of his ankle pain.  Repeat X-rays in September 2008 were normal, but showed mild bilateral flat foot (pes planus).  A bone scan in September 2008 noted increased uptake in the left ankle reported as non-specific, possibly degenerative or post-traumatic arthritis.  Left ankle magnetic resonance imaging (MRI) in November 2008 noted the tear of the ankle ligament and findings suspicious for muscle strain.  The MEB forwarded “chronic left ankle pain” for PEB adjudication.  A podiatry evaluation on 1 December 2008 showed no swelling or instability of the ankle.  The Achilles tendon was in normal alignment and non-tender.  There was tenderness to palpation of the ankle diffusely.  There was painful range of motion (ROM).  Skin examination was normal and pulses and sensation were intact.  

The MEB NARSUM examination on 08 December 2008, 2 months prior to separation, noted complaints of left ankle pain.  Physical examination showed a normal gait and stance.  There was no swelling, bruising, muscle atrophy, weakness or deformity of the lower extremities.  There was decreased left ankle dorsiflexion and painful motion.  ROM for the MEB on 8 December 2008 was left ankle DF of 15 degrees (normal 20) and plantar flexion of 45 degrees (normal), with painful motion and no additional loss of ROM with repetition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing painful limitation of motion.  The CI failed to attend the VA Compensation and Pension (C&P) evaluation scheduled in March 2009.  The VA also rated the left ankle condition 10% coded 5299-5271 (analogously to limitation of ankle motion), based on the STR, citing moderate limitation of ankle motion.  The Board concurred that a 10% rating for functional loss (§4.40, §4.45, §4.59) due to pain was appropriate as adjudicated by the PEB.  All Board members agreed the limitation of motion was no more than moderate, therefore also supported a 10% rating coded according to 5271 rating criteria.  A higher rating of 20% was not indicated in the absence of marked limited ROM of the left ankle.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to 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 left ankle condition.  

Chronic Left Foot Pain.  According to STR and the MEB NARSUM, the CI’s left foot condition also began in April 2008 after the fall, as noted above, during Basic Training.  The CI reported immediate left foot pain and swelling and X-rays were negative for acute fracture.  The CI was evaluated by a podiatrist and initially diagnosed with a grade III ankle sprain and was casted.  Following cast removal the CI was treated by PT and OT, without resolution of his ankle or foot pain.  Repeat X-rays in September 2008 noted no old or new fractures, but noted mild pes planus.  Left foot MRI in November 2004 noted changes suspicious for post-traumatic arthritis of the great toe and possibly an old healed fracture of the proximal phalanx of the toe.  The MEB forwarded “chronic left foot pain” for PEB adjudication.  At the podiatry evaluation on 1 December 2008, the CI reported left ankle pain and the examination of the left foot showed bilateral pes planus.  There was no swelling, redness, warmth or induration of the left foot.  Skin examination was normal and pulses and sensation were intact.  The MEB NARSUM examination on 08 December 2008, 2 months prior to separation, noted complaints of left ankle pain.  Physical examination showed a normal gait and stance.  There was no swelling, bruising, muscle atrophy, weakness or deformity of the lower extremities.  Foot motion was full and painless.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, coded 5010 (traumatic arthritis), citing functional loss and painful motion.  The VA also rated the left foot condition 10% coded 5299-5284 (analogous to other foot injury), based on the STR, citing moderate symptoms of foot injury, with reasonable doubt resolved in favor of the CI.  The Board considered possible higher ratings available than the 10% as adjudicated by the PEB with any applicable VASRD foot code.  There was no evidence of severe pes planus (5276), moderately severe other foot injury (5284), malunion or nonunion of a tarsal/metatarsal bone (5283), or other foot deformity (5278) for higher 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 left foot condition.  

Contended PEB Conditions:  Right Knee Patellofemoral Pain Syndrome and Right Ankle Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, 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:  In the matters of the left ankle and left foot conditions and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudications.  In the matter of the contended right knee patellofemoral pain syndrome and right ankle pain 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.  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 20140901, w/attachments
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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017900 (PD201403955)

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