RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04145
BRANCH OF SERVICE:  Army     	SEPARATION DATE:  20070817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E2, Trainee, medically separated for “left ankle pain,” 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 on 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 - 20070726	VARD - 20080829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5099-5003	10%	Left Ankle Sprain with Chronic Pain	5271	10%	20080801	
Adjustment Disorder with Depressed Mood	Not Unfitting	No VA Placement	
Slight Conductive Hearing Loss ...			
Abnormal Pap Smear …			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Ankle Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in November 2006 during Basic Combat Training while ruck marching.  Radiographic imaging demonstrated a bone contusion (posterior talar dome) and tendonopathy (posterior tibialis, no full tear).  An orthopedic consult for the MEB on 7 June 2007, documented a “small amount” of swelling, tenderness, joint stability, and the range of motion (ROM) measurements charted below.  The CI was engaged in progressive weight-bearing and the orthopedist opined that there were no surgical options.  Conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left ankle sprain” for PEB adjudication.  

At the MEB NARSUM examination on 20 June 2007, the CI reported pain with ambulation and an inability to walk without a controlled ankle movement (CAM) boot.  The examiner noted tenderness, “mild” edema, and painful motion.  The NARSUM cited physical therapy ROM measurements taken the same day for the MEB as charted below.

A VA Compensation and Pension (C&P) examination was conducted 1 August 2008, 12 months after separation, and there was no documentation of interim injury or other exacerbation of the condition.  The CI reported continued ankle pain rated 3-10/10 and no longer required a brace or ambulatory assistive device.  The examiner recorded normal alignment and an absence of swelling, tenderness, and joint instability.  Measured ROM was limited and painful as charted below.   

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation are summarized in the chart below.  
Left Ankle ROM
(Degrees)	Ortho ~2 Mo. 
Pre-Sep	MEB ~2 Mo.
Pre-Sep	VA C&P ~12 Mo.
Post-Sep	
Dorsiflexion (20 Normal)	15	20	0	
Plantar Flexion (45)	“Full”	30	40	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (arthritis, degenerative), citing the US Army Physical Disability Agency Policy pain policy.  The VA also assigned a 10% rating using the 5271 code (ankle, limited motion of) based on the VA C&P examination 12 months after separation, citing “moderate” limitation of motion.  The Board considered if the ROM limitation could be fairly characterized as “marked” in support of a 20% rating under 5271, but members agreed that the ROM examinations proximate to separation were consistent with a moderate limitation; thus a 10% rating under 5271 would not be advantageous.  Members also considered using code 5284 (foot injuries, other) rated 20% for “moderately severe” disability, but members agreed that the evidence did not support the presence of that degree of disability; alternative VASRD ankle and analogous codes were all less applicable and also 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.  

Contended PEB Conditions: Adjustment Disorder With Depressed Mood, Slight Conductive Hearing Loss and Eustachian Tube Dysfunction, Abnormal Pap.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.   There were no outpatient mental health (MH) records in the available STR, but the NARSUM documented that the CI was followed by psychiatry and had “not required any medications, just counseling.”  There was no claim, psychiatric evaluation, or rating for any MH condition in the available VA file.  The hearing and gynecologic diagnoses were both later (penciled in) additions to the NARSUM without elaboration.  An audiogram accomplished 2 days after the NARSUM was normal except for a mild-range deficit in the highest frequency for the left ear.  There was no STR documentation of any clinical acuity of the gynecologic condition (as would be expected from the nature of the diagnosis).  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 matter of the left ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder with depressed mood, slight conductive hearing loss and Eustachian tube dysfunction, and abnormal pap 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 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 
AR20160011598 (PD201404145)

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