RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00154
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Heavy Construction Equipment Operator, medically separated for “chronic left foot and ankle pain,” with a disability rating of 10%.

CI CONTENTION:  CI contended he should have received a 30% disability rating.  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 - 20051207	VARD - 20061211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Foot and Ankle Pain	5003	10%	Traumatic Arthritis, Left Ankle with Limitation of Motion	5010	10%	20060809	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Lower Extremity.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had insidious onset of left foot and ankle pain that began approximately 3 years prior to referral for MEB.  Left foot X-rays on 31 July 2002 were normal (tarsal, metatarsal, and phalanges were normal in appearance) except for posterior calcaneus enthesopathy (disorder of the muscular or tendinous attachment to bone) at the insertion site of the Achilles tendon.  Left ankle diagnostic imaging (MRI) showed an osteochondral (bone and cartilage) defect of the medial talar (ankle bone that articulates with tibia, calcaneum and navicular) dome and evidence of a remote injury of the anterior talofibular ligament (ATFL).  On 17 February 2005 the CI underwent left ankle arthroscopy to repair a talus osteochondral defect.  An 11 May 2005 left ankle X-ray was unremarkable except for a minimal bony spur of the anterior distal tibia.  A 17 August 2005 left ankle MRI showed an osteochondral injury at the medial talar dome, Achilles tendonitis, mild tendon tears, mild plantar fasciitis, chronic near complete tear of the ATFL, small anterior osteophytes at the distal tibia, and mild edema.  The 12 September 2005 orthopedic surgery physical examination documented a normal gait, stance, and posture.  Left ankle range of motion (ROM) was dorsiflexion of 15 (20 normal) and plantarflexion of 50 (45) degrees.  The ankle anterior drawer (assesses ATFL) and lateral stress (assesses lateral ligaments) tests were positive and the medial stress (assesses medial ligaments [deltoid ligament]) test was negative.  The bilateral foot examination revealed pes planus on the left and a normal arch on the right.  Sensation, and deep tendon reflexes (DTRs) were normal.  Strength was normal (5/5) except for the tibialis posterior (3/5).  At a 27 September 2005 orthopedic surgery evaluation, the CI complained of left lateral ankle pain.  The examiner documented status post left ankle debridement/microfracture with good evidence of healing by X-ray and MRI.  The left ankle examination revealed joint line tenderness (lateral > medial) and generalized laxity.  Pain-free left ankle ROM was dorsiflexion of 20 (normal 20) and plantarflexion of 35 (normal 45) degrees.  Strength, sensation, and pulses were normal.  

The 24 October 2005 NARSUM, 3 months before separation, recounted the history and interventions.  The CI complained of a 3 year history of chronic left foot and ankle pain.  He reported insidious onset with no history of trauma.  Pain was exacerbated by running, marching, climbing, and crawling.  The CI did not experience significant improvement from conservative treatment which included nonsteroidal anti-inflammatory medications, rest, activity modification, profiles, and injections.  The physical examination revealed the left lower extremity was neurovascularly intact.  “He has noted pes planus.  On palpation, he has Achilles tendinitis as well as plantar fasciitis.”  The left ankle was stable to inversion and eversion.  Left ankle ROM was dorsiflexion of 20 degrees and plantarflexion of 35 degrees.  The examiner recounted the findings of the X-rays and MRI.  The assessments listed degenerative joint disease of the tibiotalar joint with talar dome osteochondral lesion and osteophyte formation; posterior tibial tendon dysfunction; chronic Achilles tendinitis; and chronic plantar fasciitis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, coded 5003 code (arthritis, degenerative) citing chronic left foot and ankle pain, insidious onset, degenerative changes of the talo-tibial joint by imaging, slight loss of motion, good stability, pes planus deformity, Achilles tendon tenderness, and plantar fascia tenderness.  The VA assigned a 10% rating, coded 5010 code (arthritis, due to trauma) based on the VA C&P examination 7 months after separation, citing limitation of motion and X-ray evidence of arthritis.  While there was left plantar fasciitis (analogizes to 5020 [synovitis] per analogous codes) by examination and MRI, it was characterized as mild.  While there was left pes planus by examination, Board members agreed the condition did not exceed the mild (0%) under 5276 (flatfoot, acquired).  There was no weakness for consideration under 5277 (weak foot).  There was no evidence of sensory pathology for consideration under 5279 (metatarsalgia).  There was no deformity for consideration under 5278 (claw foot), 5280 (hallux valgus), 5281 (hallux rigidus), 5282 (hammer toe), or 5283 (metatarsal bones malunion/nonunion of).  There was no deformity for consideration under 5270 (ankle, ankylosis), 5272 (subastragalar or tarsal joint, ankylosis of), or 5273 (os calcis or astragalus, malunion of).  There was no excision of the astragalus for consideration under 5274 (astragalectomy).  The proximate orthopedic surgery and NARSUM examinations documented near normal (45) plantar flexion (50, 35, and 35 degrees) and near normal (20) dorsiflexion (15, 20, and 20 degrees).  Board members agreed that the ROM values more closely approximated the moderate (10%) than the marked (20%) rating under 5271 (ankle, limited motion of).  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.  

BOARD FINDINGS:  In the matter of the left lower extremity condition 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 20140221, 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, AR20160018500 (PD201500154)

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