RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00983
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070529

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aerospace Maintenance, medically separated for “chronic right ankle pain…” with a disability rating of 20%.

CI CONTENTION:  The CI requested a review of all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20070410	VARD – NA 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain…	5271	20%	No VA Examination in Evidence	
Right Knee Pain…	Cat II		
Mild Right Ulnar Neuropathy…	Cat II		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right ankle arthroscopic surgery in November 2005 for debridement of talar osteochondral lesion (damage to a piece of cartilage and underlying bone).  An additional surgery was subsequently performed in June 2006 which involved transfer of an osteochondral graft from a right knee donor site to the injured area of the right ankle (talar dome).

The MEB NARSUM on 13 October 2006, 4 months after surgery and 8 months prior to separation, recorded complaints of sharp, aching pain and swelling over the anterolateral right ankle.  The CI could not run, stand for long periods of time, bicycle or tolerate exercise.  He used a walking boot during duty hours for pain and occasionally a cane.  Physical examination noted an antalgic gait, and right ankle tenderness and mild swelling.  Some tenderness of the well-healed anterolateral surgical incision was present.  Right ankle dorsiflexion was 5 degrees (normal 20) and plantar flexion was 40 degrees (normal 45).  A follow-up orthopedic examination on 10 January 2007 (7 months after surgery and 5 months prior to separation) observed no right ankle swelling and “near FROM (full range of motion)” of the ankle.

There was no VA examination in evidence within the 12-month allowable window for adjudication.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, coded 5271 (ankle, limited motion of).  Since a 20% rating is the highest available under the 5271 code, the panel considered other routes to a higher rating.  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints to warrant consideration under the respective codes (5270, 5272).  Although applicable in this case, the 5273 code (malunion of talus) has a maximum rating of 20%, which offers no advantage to the CI.  The 5284 (foot injuries, other) and 5274 (astragalectomy) codes were inapplicable.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right ankle condition.  

Contended PEB Conditions:  Right Knee Pain and Mild Right Ulnar Neuropathy.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The CI non-concurred with the Informal PEB’s adjudication that these conditions were not unfitting.  However, a Formal PEB also concluded that right knee pain and ulnar neuropathy were not unfitting.  

Right Knee Pain: The CI experienced right knee pain after surgery in June 2006 which, according to the NARSUM examiner in October 2006, was improving with use of a brace.  Although the NARSUM (4 months after surgery) implied that “milder chronic right knee pain” interfered with military duties, the examiner indicated that only the profile restrictions attributable to the ankle condition rendered the CI unfit.  Temporary profiles from June 2006 through November 2006 imposed limitations for a diagnosis of “surgery (right ankle and knee).”  The final profile in evidence dated 6 December 2006 was “L4” and listed no diagnosis.

Mild Right Ulnar Neuropathy: The CI developed a right ulnar neuropathy as a consequence of right arm positioning during surgery in June 2006.  Symptoms were numbness and tingling of the medial hand and little finger.  Electrodiagnostic studies in October 2006 documented a mild ulnar neuropathy at the elbow.  At a clinic visit for evaluation of a right wrist sprain on 4 January 2007, the CI denied right hand numbness or tingling.  There were no profile restrictions related to the upper extremity.  On the Report of Medical Assessment on 5 April 2007 (2 months prior to separation) the CI did not indicate that ulnar neuropathy was a condition that interfered with his performance of duty.

There was no performance-based evidence from the record that these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended right knee pain or ulnar neuropathy conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic right ankle pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended right knee pain and mild right ulnar neuropathy conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150608, w/attachments
Exhibit B.  Service Treatment Record

SAF/MRB

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Dear XXXXXXXXXXXXXXXXXX

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00983.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,