RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00144
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Patriot Fire Control Operator, medically separated for “left ankle pain following ankle fracture,” 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 - 20041116	VARD - 20051110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain Status Post Fracture	5010	10%	Residuals, Left Ankle Injury	5010-5271	10%	20050715	
			Surgical Scar, Left Ankle	7804	10%	20050715	
Degenerative Joint Disease, Bilateral Knees	Not Unfitting	Tendonitis, Right Knee	5024	10%	20050715	
		Tendonitis, Left Knee	5024	10%	20050715	
Low Back Pain	Not Unfitting 	Low Back Strain	5237	10%	20050715	
PTSD	Not Unfitting	PTSD	9411	10%	20050726	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.   According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a severe fracture of his left ankle while attending Air Assault School.  He subsequently underwent ankle surgery and since then he has had two additional surgeries, one included reconstruction of his ligament.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “arthritis, post-traumatic, left ankle” for PEB adjudication.
At the MEB examination dated October 2004, 4 months prior to separation there was Achilles tenderness on the left ankle, a 2 cm surgical scar and mild swelling.  Motor strength was normal and range of motion (ROM) was noted to be full.

The NARSUM examination in November 2007, 3 months prior to separation, noted the CI’s report of pain with intensity of 10/10 with activity.  At times his pain was relieved with nonsteroidal medications.  Physical examination noted his ligaments were stable to varus and valgus stressing, and the left ankle demonstrated well-healed surgical scars.  There was tenderness to palpation along the joint line.  ROM recorded dorsiflexion of 10 degrees (normal 20), and plantar flexion of 30 degrees (normal 45).  Radiographs of the left ankle reported findings consistent with early arthritic changes.

The VA Compensation and Pension (C&P) examination was accomplished 5 months after separation.  The CI reported he had intermittent flares of sharp pain in the left ankle which occurred about 4-5 times a week, depending on activities.  His pain was alleviated by stretching and taking medications (Motrin).  The CI wore an ankle brace, which he stated helped him when walking and decreased the pressure in the left ankle.  He did not use a cane or crutches for walking.  Physical examination of the left ankle revealed mild tenderness of the ankle, no swelling, and no abnormality noted in the scars.  ROM dorsiflexion was recorded at 15 degrees with pain, and plantar flexion to 45 degrees with pain.  There was no additional weakness, fatigability, incoordination, or functional impairment with repetitive testing.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the VA and PEB assigned a 10% rating, but with different coding scheme.  The PEB used the 5010 code (arthritis due to trauma) based on painful or limited motion, and the VA coded the condition analogously 5010-5271 (ankle, limitation of motion, moderate).  The VA also assigned a 10% rating under the 7804 code (scar(s), unstable or painful), for a painful scar.  The Board considered the 5271 code to determine if a higher rating was justified.  The Board agreed that the ROM examinations proximate to separation were consistent with no more than a moderate limitation of motion at the time of separation.  The CI had 10 degrees of dorsiflexion and 30 degrees of plantar flexion, and was not using an assistive device.  The Board agreed, the evidence did not justify a rating consistent with marked limitation of motion at the time of separation.  The Board found no other VARSD path to a higher 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.  Bilateral knees, low back and posttraumatic stress disorder (PTSD).  The bilateral knees, low back and PTSD conditions were not profiled or implicated in the commander’s statement.  PTSD was not judged to fail retention standards.  There was no performance based evidence from the record that any of these 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 the bilateral knees, low back and PTSD 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 20141230, 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, AR20160018492 (PD201500144)

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