RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	     CASE:  PD-2015-00131
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20041023 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Military Policeman, medically separated for right ankle pain, rated at 0%, 

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities. He was not evaluated for heartburn, PTSD, anxiety or depression.  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 IPEB – Dated 20040706	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Residuals of Injury with Peroneal Neuritis, Right Ankle	8622	0%	Residuals Of Injury with Peroneal Neuritis, Right Ankle	8622	0%	20040812	
Other Conditions x 0 (Not In Scope)	Other x 1	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20041203 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Right Ankle Pain.  The record shows that the CI injured his heel during a ruck march and was first evaluated on 27 November 2001 when he reported a 2-month history of pain.  His examination was notable for a “lump” on his right heel, but the range of motion (ROM) was full.  He was treated conservatively with duty restrictions, medications, and an arch support.  He was next seen on 17 January 2002 and reported pain with activity.  The ROM was again normal.  An X-ray on 28 May 2002 noted thickening of the heel bone (calcaneus), but no true spur (associated with plantar fasciitis) was present.  He was treated for the next few months in physical therapy (PT) for Achilles tendonitis.  He was noted to have reduced dorsiflexion (toes up) in PT on 25 June 2002.  He deployed from 6 January 2003 until 15 August 2003.  Following redeployment, he passed his physical fitness test in September 2003.  He was seen on 13 November 2003 in primary care and reported chronic right ankle pain.  His examination was normal including the ROM.  He was referred to podiatry where, when seen on 2 December 2003, he reported chronic pain and a 3-month history of lateral (outside of the foot) numbness aggravated by activity.  X-rays that day were normal.  He was referred for electrodiagnostic studies (EDX) which showed a right peroneal neuropathy on 21 January 2004.  Dorsiflexion was reduced bilaterally in PT on 5 March 2004.  An MRI on 17 March 2004 was unremarkable.  He was not an operative candidate and could not meet duty requirements.  He was then referred for MEB.  

At the medical examination, dated 03 May 2004, 6 months prior to separation, the CI reported numbness and tingling in the right foot and that he was unable to run.  On examination, he was unable to dorsiflex (toes up) his foot and plantar flexion (toes down) was limited.  Toe walk was poor, but heel walk normal.  He was tender to palpation, but without edema.  The ROM for the MEB was done in PT 4 days later and is charted below.  Dorsiflexion was reduced, but symmetric between the ankles.  Plantar flexion was reduced 5 degrees on the right from the left.  At the MEB narrative summary (NARSUM) podiatry addendum examination dated 11 May 2004, 5 months pre-separation, the examiner noted prolonged conduction times for the right superficial peroneal nerve (abnormal).  Moderate non-pitting edema (usually from damage to the lymph drainage system as might be seen after a sprained ankle) was present.  Motor function was normal in all ankle planes.  Sensation was decreased over the top of the right foot.  

The MEB NARSUM examination was dated 25 May 2004, 5 months pre-separation, documented that the CI had difficulty with his ankle since an inversion injury in November 2001.  The examiner cited the 3 May 2004 examination under the objective findings.  At the VA Compensation and Pension (C&P) examination dated 12 August 2004, 2 months pre-separation, the CI reported longstanding right foot and ankle pain despite treatment.  On examination, edema was absent and his gait normal.  No sign of abnormal weight bearing was present.  The ROM was normal and painful motion absent.  An X-ray was normal.  A primary care note dated 22 March 2006, 17 months after separation, documented that the CI’s hobbies included golf, hunting, and cycling.  

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Ankle ROM
(Degrees)	PT
~12 Mos. Pre-Sep	PT
~8 Mos. Pre-Sep	MEB Adden PT
~5 Mo. Pre-Sep	VA C&P
~2 Mo. Pre-Sep	
Dorsiflexion (20 Normal)	FAROM	-5 (0 Left)	5 (5 Left)	20	
Plantar Flexion (45)	FAROM	40 (45 Left)	35 (40 Left)	45	
Comment		Non-antalgic gait	No comment on pain	No painful motion	
§4.71a Rating	0%	20%	20%	0%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right ankle at 0%, coded 8622 (neuritis of the superficial peroneal nerve).  The PEB noted that the limitation in motion was symmetric between the right ankle and unaffected left ankle.  The VA examination was normal.  The CI was limited in activity on his profile, but the wear of military footwear was not restricted.  The limitation in motion of the right ankle would support a 10% or 20% rating except that it is symmetric (or nearly so) with the left ankle.  The VA examination, the most proximate to separation, was normal, and supports a 0% rating.  Post-separation evidence indicates that the CI was able to play golf and hunt, consistent with the normal VA examination and PT examination 12 months prior to separation.  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 right ankle superficial peroneal nerve injury condition.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD§4.71a and §4.124a, 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 20150202, 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 XXXXXXXXXXXXXXXXXXXX, AR20160014222   (PD201500131)

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