RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04012
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “bilateral ankle degenerative joint disease (DJD)” with a disability rating of 10%.  

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 - 20071023	VARD - 20080107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Ankle Degenerative Joint Disease…	5003	10%	Left Ankle Sprain	5099-5024	10%	20070910	
			Right Ankle Sprain		10%		
Right Knee Pain	Not Unfitting	Right Knee Strain		10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Ankle Degenerative Joint Disease Condition.  According to service treatment records (STR) the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s ankle pain condition began in May 2007 after participating in combatives training.  The MEB forwarded left and right ankle pain for PEB adjudication.  At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated October 2007, 1 month prior to separation, the CI reported bilateral ankle pain and swelling that hurt to walk.  The physical examination showed bilateral ankle tenderness to palpation.  The examiner noted swelling to both ankles and the CI could stand on his toes and could not stand on his heels.  The range of motion (ROM) was right and left dorsiflexion to 0 degrees (normal is 20), left plantar flexion to 40 degrees (normal 45 degrees) and right plantar flexion to 45 degrees.  

At the 10 September 2007 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported weakness, pain, lack of endurance, instability, stiffness after sitting 5 minutes or more, swelling after walking more than 10 minutes and fatigability after walking for 15 minutes.  The pain was reported as burning, aching, sharp and sticking in nature. The pain was elicited by physical activity and was relieved by rest.  The CI stated that he could function without medication and that his condition did not cause incapacitation.  Physical examination showed right ankle ROM was limited by pain.  There was no instability or tenderness of the right ankle.  The left ankle examination was normal.  The ROM was normal bilaterally (right and left dorsiflexion to 20 degrees and left and right plantar flexion to 45 degrees).  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB combined the bilateral ankle degenerative joint disease condition under a single disability rating, coded 5003, citing a ROM of 45 degrees right and 40 degrees left.  Although VASRD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  The Board must follow suit (IAW DoDI 6040.44) if the PEB combined adjudication is not compliant with the latter stipulation, provided that each ‘unbundled’ condition can be reasonably justified as separately unfitting in order to remain eligible for Service rating.  If the members judge that separately ratable conditions are justified by performance based fitness criteria and indicated IAW VASRD §4.7 (higher of two evaluations), separate ratings are recommended; with the stipulation that the result may not be lower than the overall combined rating from the PEB.  In this case, both ankles were considered to fail retention standards; both were implicated by the NARSUM and in the commander’s statement; and, both were profiled.  Members agreed, therefore that each ankle should be conceded as separately unfitting; and, that coding and rating features were logically identical.  The VA rated the left and right ankle sprain conditions 10% each analogously coded 5099-5024 (tenosynovitis), based on the VA C&P examination 2 months prior to separation, citing painful or limited motion of both ankles.  Although there was insufficient ankle limitation of motion to support a minimum rating under the ankle codes, the Board agreed a 10% rating for each ankle was justified for the presence of painful motion.  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 each ankle condition, for a combined rating of 20% analogously coded 5099-5024.  

Contended PEB Conditions:  Right Knee Pain (strain).  The right knee was noted in the profile, but was not 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 the right knee 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 contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right and left ankle conditions, the Board unanimously recommends a disability rating of 10% for each ankle, coded 5099-5024 IAW VASRD §4.71a.  In the matter of the contended left knee pain condition, 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Ankle Pain	5099-5024	10%	
Left Ankle Pain		10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
AR20160017770 (PD201404012)

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 20% 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