RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-04265
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20030509

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Bradley Linebacker Crewmember, medically separated for “left ankle and foot pain…” with a disability rating of 10%. 

CI CONTENTION:  The CI is “still having issues” with his condition and he was not fully informed.  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 - 20030417	VARD - 20030813	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle and Foot Pain	5283	10%	Left Foot, Status Post Fusion…	5271	10%	20030614	
			Scar, Left Ankle	7804	10%	20030614	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Ankle and Foot Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), in January 2002, this CI started having problems with his left foot and ankle.  On 24 September 2002, he had surgery on the left ankle.  After surgery, he continued to have persistent problems with his left lower extremity (LLE), and an MEB was initiated.  At the MEB NARSUM on 9 April 2003 the CI reported that he felt okay at rest, but any type of weight bearing activities (walking, standing, running, squatting, jumping) caused pain and cramping in the LLE.  He was wearing custom orthotics, which enabled him to pursue his level of functional activity.  The MEB physical examination (PE) was done on 27 March 2003.  Focused PE of the left ankle showed some tenderness to palpation, but no joint warmth or effusion.  Ankle range of motion (ROM) was measured and is summarized in the chart below.  The NARSUM examiner’s diagnosis for the LLE was “left ankle and foot: bone fusion defect, with more than moderate pain, loss of function, and decreased ankle range of motion.”

The CI separated from service on 9 May 2003.  One month later, on 14 June 2003, he had a VA Compensation and Pension (C&P) examination and noted he was working part-time, delivering pizza.  He reported pain in both ankles and feet, left worse than right.  On examination, the CI walked briskly in the hallway, with normal gait and posture.  He was able to fully squat, but was not able to walk on heels and toes.  He climbed onto the examination table without difficulty.  PE of the left foot showed no deformity or tenderness.  Left ankle ROM was measured and is shown in the chart below.

Left Ankle ROM
(Degrees)	MEB ~1 Mo. Pre-Sep
(20030409)	VA C&P ~1 Mo. Post-Sep
(20030614)	
Dorsiflexion (20 Normal)	8	10	
Plantar Flexion (45)	15	20	
VASRD Rating	10%	10%	
	
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5283 code (tarsal, or metatarsal bones, malunion of, or nonunion of), citing ‘moderate’ nonunion of a stress fracture of talus.  The VA also assigned a 10% rating using the 5271 code (ankle, limited motion of) based on the VA C&P examination 1 month after separation, citing no callosity, deformity or tenderness.  The VA also assigned a separate 10% rating for a painful scar.  The Board does not recommend separation rating for scars unless their presence imposes a direct limitation on fitness.  The Board reviewed the STR and did not find evidence that a tender or painful scar separately interfered with duty and therefore a separate rating was not recommended.  

The PEB combined the left ankle and the left foot into a single unfitting condition.  The Board evaluated whether or not it was appropriate for the two pain problems to be “bundled” together.  The Board must determine if the PEB’s approach of combining the conditions under a single rating was reasonably justified in lieu of separate ratings.  The Board must apply separate codes and ratings in its recommendation if compensable ratings for each condition are achieved IAW the VASRD.  If the Board judges that two or more separate ratings are warranted, it must satisfy the requirement that each ‘unbundled’ condition was separately unfitting.  After due deliberation, the Board determined that the evidence does not support a conclusion that each of the pain problems, separately, would have rendered the CI unable to perform his required military duties.  Accordingly, the Board does not recommend a separate service disability rating for each pain problem.  It is reasonably justified for the left ankle and the left foot to be “bundled” together, and treated as a single unfitting condition.  

The Board determined that, at the date of separation (DOS), the CI’s disability was best described as “moderate.”  There was insufficient evidence in the record to justify classifying his condition as “moderately severe” or “severe.”  Therefore, the Board agreed that a 10% rating was appropriate in this case.  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 unfitting left ankle and foot pain condition.  

BOARD FINDINGS:  In the matter of the left ankle and foot pain, due to bone fusion defect, and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20141107, 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 
XXXXXXXXXXXXXXXXXX, AR20160018326 (PD201404265)

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