RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00145
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Mental Health Specialist, medically separated for “Osteochondral defect, left talus” 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 confined to 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 - 20080328	VARD - 20081215  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteochondral Defect, Left Talus	5271	10%	Osteochondral Defect, Left Talus	5010-5271	10%	20080917	
Bunion Deformity Bilateral	Not Unfitting	Bilateral Hallux Valgus and Pes Planus	5276	0%	20080917	
RATING:  10%	RATING:  40%	

ANALYSIS SUMMARY:  

Osteochondral Defect, Left Talus (ankle/foot bone).  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed left ankle pain after physical training.  Initially treated as an ankle sprain, her painful symptoms returned when she again resumed running activities.  Upon Orthopedic examination and radiologic imaging, the CI was diagnosed with osteochondral defect (OCD…a condition whereby there is damage to joint cartilage and underlying bone).  Despite surgical intervention and aggressive physical therapy (PT) her pain continued to the degree of not allowing unrestricted duty.  The MEB forwarded “Osteochondral defect left talus with chronic ankle pain” for PEB adjudication.  

At the MEB NARSUM examination dated 3 December 2007 (5 months prior to separation), the CI reported continued left ankle pain causing an inability to run, ruck march, or perform rushes.  Her physical examination (PE) revealed painful motion about the left ankle.  Her gait was described as “minimally asymmetric antalgic.”  Ankle range of motion (as measured with a goniometer) was normal excepting 10 degrees of dorsiflexion (normal = 20).  Her diagnosis remained unchanged.  At the VA Compensation and Pension (C&P) examination dated 17 September 2008 (5 months after separation), the CI reported painful flare-ups of the left ankle precipitated by prolonged walking and or utilizing exercise equipment.  Her PE revealed mild tenderness and swelling about the left ankle.  There was decreased and painful motion present.  Ankle range of motion (ROM) remained normal excepting 5 degrees of dorsiflexion (normal = 20).  

The Board directed attention to its rating recommendation based on the above evidence.  Utilizing the same primary VASRD code of 5271 (ankle; limited motion), both the PEB and VA rated the condition at 10% (moderate impairment) citing limited motion.  All Board members agreed that the persistent limitation of ankle dorsiflexion with normal plantar flexion did not support a level of “marked” (20%) impairment, but rather that of “moderate” severity at 10%.  The Board also considered alternative VASRD ankle and analogous codes (to include painful motion [§4.59]), but all were less applicable and not advantageous to the PEB’s current 10% 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 Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that the bilateral bunion deformity was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The bunion deformities were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   The condition was reviewed and considered by the Board.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended bilateral bunion 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 bilateral bunion condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141229, 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, AR20160018493 (PD201500145)

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