RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00829
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Laundry and textile Specialist, medically separated for “chronic right ankle pain” with a disability rating of 0%.  

CI CONTENTION:  The CI contended asthma, depression and adjustment disorder.  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 - 20030708	VARD - 20040302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	0%	Residuals Stress Fracture Right Ankle	5271-5024	10%	20030811	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in April 2001 during basic training without specific injury.  Radiographic studies (X-rays) were normal but a month later, the CI had a bone scan which revealed a stress fracture located in the right distal tibia extending to the malleolar level (ankle joint level).  After 30 days convalescent leave, multiple temporary profiles, and a few physical therapy visits, a repeat bone scan in May 2002 noted diffuse stress changes.  The CI was evaluated by sports medicine and multiple sites of tendonitis, plantar fasciitis and pes anserine bursitis (tendon/bursa below the knee) were diagnosed.  A walking boot for 4 to 6 weeks was recommended, followed by a P2 profile or MEB if no improvement.  Orthopedic evaluation noted there was no surgical indication.  At a sports medicine follow-up on 30 October 2002 the CI reported pain with weight bearing the radiated up the right side of her leg and intermittent swelling.  She reported numbness and tingling and even the sheet at night caused pain.  A diagnosis of possible reflex sympathetic dystrophy (RSD) was considered; she was given appropriate medications to try and offered injections, which she declined.  The MEB forwarded chronic right ankle pain for PEB adjudication.  

At the MEB examinationon 16 December 2002, 10 months prior to separation, the CI reported numbness in right ankle.  The CI also noted that her right ankle was sensitive to cold weather and that it was difficult to walk and run.  The physical examination showed no edema and no deformities.  

The MEB NARSUM examination on 4 June 2003, 4 months prior to separation, the CI reported she had orthotics but could not tolerate boots.  She was wearing tennis shoes.  The CI reported chronic aching pain with difficulty with prolonged standing or walking on uneven ground.  The examiner noted a normal gait, with no swelling or bruising.  There was diffuse tenderness to palpation (TTP) about the ankle, especially the Achilles tendon.  The right ankle range of motion (ROM) for dorsiflexion was 10 degrees and 40 degrees for plantar flexion.  The CI had a normal gait and normal pulses and sensation.  

At the 11 August 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported continuous chronic pain in her right ankle and worsened with prolonged standing, walking and running.  She was not using a brace or assistive device for ambulation.  She was taking prescription anti-inflammatory medication daily.  The physical examination noted the ankles and feet were symmetrical bilaterally.  Posture, gait, and balance were normal. There was no tenderness, edema, swelling, inflammation or foot malalignment.  There was mild to moderate pes planus bilaterally.  The CI was able to perform the heel-to-toe maneuver with some discomfort.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right ankle pain condition 0% coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the chronic right ankle pain condition 10% coded 5271-5024 (tenosynovitis), based on the VA C&P examination 2 months after separation, citing slight limitation of motion on dorsiflexion.  

The Board agreed that the ROM examinations proximate to separation at both the MEB and VA C&P exams were consistent with a moderate limitation of motion for the 10% rating under this code.  All Board members agreed the limitation of motion was no more than moderate and therefore a higher rating of 20% was not indicated for marked limited ROM of the ankle.  The Board considered alternative VASRD ankle and analogous codes.  There was no ankylosis, nonunion or malunion, therefore VASRD §4.71a offers no applicable joint code which would yield a higher rating, except possibly 5284 (other foot injuries).  The Board considered whether ratings under 5284 provided a higher rating (§4.7), however all Board members agreed that the impairment did not more nearly approximate a moderately severe condition to support a higher rating under 5284.  The Board also considered if rating the ankle condition IAW VASRD §4.124a was supported given the consideration of RSD by the sports medicine specialist.  However, there was no further mention of this diagnosis at the MEB NARSUM or the VA C&P exam; the CI no longer appeared to be taking medications for RSD and neither examination noted objective findings characteristic of RSD.  Therefore, the Board abandoned this ratings approach.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic right ankle pain condition, coded 5271.  

BOARD FINDINGS:  In the matter of the chronic right ankle pain condition, the Board unanimously recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Ankle Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150605, 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, AR20170000915 (PD201500829)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA