RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00110
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Fire Support Specialist, medically separated for “chronic left ankle pain [status post] Brostrom Procedure,” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”  His 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 - 20090320	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain…	5099-5003	10%	No VA Claim	
Moderate-Severe Sensori- Neural Hearing Loss, Bilaterally	Not Unfitting		
Esophageal Reflux Disease	Not Unfitting		
Headache Syndrome	Not Unfitting		
Left Shoulder Pain	Not Unfitting		
Attention-Deficit Hyperactivity Disorder, Inattentive Type	Condition Not Constituting a Physical Disability		
RATING:  10%	RATING:  NA	

ANALYSIS SUMMARY:  

Left Ankle Pain [Status Post] Brostrom Procedure.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began after a fall from a Blackhawk helicopter during a training exercise in 2001.  Repetitive strains, persistent lateral ankle pain, and periods of instability led to surgery (arthroscopic synovectomy with lateral ligament stabilization) in March 2006.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left ankle pain status post Brostrom repair” for PEB adjudication.  

At the MEB examination (documented on DD Forms 2697, 2807-1 and 2808) in October and November 2008 (8 and 7 months prior to separation), the CI reported constant pain that increased when wearing gear and the use of an ankle brace.  The physical examination showed an antalgic gait with “decreased stance phase on the left.”  There was pain with inversion and no evidence of swelling, deformity, crepitus or instability.  Radiographic evaluations (X-rays and MRI) in October 2008 documented intact ligaments with evidence of chronic scarring, and no evidence of fracture, dislocation or bony defects.  

At the MEB NARSUM examination dated 3 February 2009 (5 months pre-separation), the CI reported baseline 3/10 pain with flares occurring daily, worsened by prolonged standing and walking, and walking on uneven terrain.  He also reported decreased range of motion (ROM) due to pain and exacerbations.  The physical examination showed tenderness about the ankle, pain with ambulation, weight bearing, and with all ROMs.  Dorsiflexion was to 18 degrees (normal 20), and plantar flexion was to 35 degrees (normal 40).  There was normal strength and no evidence of instability.  There was no VA Compensation and Pension (C&P) evaluation in evidence for review.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the left ankle condition, analogously coded 5099-5003 (degenerative arthritis), citing pain and limitation of motion.  There was evidence of painful motion in support of the 10% that was adjudicated by the PEB.  The Board considered a higher rating under the diagnostic code 5271 (ankle, limited motion), and whether the limitation of motion was marked.  All Board members agreed the limitation of motion was no more than mild, therefore the higher rating of 20% was not supported.  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.  

Contended PEB Conditions:  Sensorineural Hearing Loss, Esophageal Reflux Disease, Headache Syndrome, and Left Shoulder Pain, Attention Deficit Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The sensorineural hearing loss was profiled, however none of the remaining conditions were profiled.  There was no commander’s statement in evidence.  None of the conditions were 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.  Attention Deficit Disorder does not constitute a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB determination of the contended condition and so no additional disability rating is 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 sensorineural hearing loss, esophageal reflux disease, headache syndrome, and left shoulder pain conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  In the matter of the contended attention deficit disorder condition, the Board unanimously agrees that it does not constitute a physical disability and cannot recommend it for disability rating.  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 20140714, 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 XXXXXXXXXXXXXXXXXXXXX, AR20170002527 (PD201500110)

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