RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01408
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E4, Intelligence Analyst, medically separated for “chronic bilateral ankle pain,” with a disability rating of 20%.

CI CONTENTION:  He has other disabilities related to his discharge.  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 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 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 - 20090515	VARD - 20070730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Ankle Pain
(10% R + 10% L w/ BLF)	5099-5003	20%	Instability and Strain, Left Ankle 	5271	0%	20070307	
			Instability and Strain, Right Ankle	5271	0%		
Bilateral Plantar Fasciitis	Not Unfitting	Left Plantar Fasciitis	5099-5020	0%		
		Right Plantar Fasciitis	5099-5020	0%		
Left Heel Bone Spur	Not Unfitting	No VA Placement		
Hypertension	Not Unfitting	Hypertension	7101	NSC		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Bilateral Ankle Pain.  The Board notes that the only VA evaluation in evidence (charted above) was from an earlier period of active duty and was conducted over 2 years before the adjudicated separation.  As elaborated above, the Board’s assessment must be derived from evidence that can be reasonably interpreted to reflect disability at the time of separation.   Therefore the evidence from the Service record was assigned the determinant probative value with respect to the Board’s recommendation.   
According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was diagnosed with congenital mild varus angulation (prone to ankle sprains).  He developed increasing bilateral ankle pain and subjective instability in 2005 (previous period of active duty) with extensive running and physical training.  He suffered a sprain (inversion injury, Grade I) of his right ankle in January 2009 soon after a return to active duty. He persisted with bilateral pain (right greater than left) and subjective instability; and, an orthopedic consultant opined that there was “more of a pain issue than an instability issue” and stated that surgery was not indicated.  There were multiple STR clinical entries that documented a normal gait, grossly normal range of motion (ROM) with painful motion, and no objective instability.  There were no significantly probative contrary entries.  A trial of conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “chronic bilateral ankle pain” to the PEB.

The NARSUM examination on 13 April 2009 (2 months before separation) documented “constant daily pain” of the right ankle and “intermittent [pain] ... with physical activity” on the left; and, noted the use of “braces with any physical training.”  Functional limitations were running, prolonged walking, and load-bearing.  The physical examination recorded bilateral tenderness “right greater than left,” no atrophy, normal strength (5/5), and “no ankle instability bilaterally.”  Goniometric ROM measurements were bilateral dorsiflexion to 15 degrees (normal 20) and plantar flexion to 25 degrees right and 30 degrees left (normal 45), specifying painful motion and the absence of ROM degradation with repetition.  As noted above, there was no temporally probative VA or other post-separation evidence in this case.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s separate 10% ratings under code 5099-5003 (analogous to degenerative arthritis) referenced the VASRD, and were consistent with VASRD §4.71a criteria for the service ROM (conceding painful motion) and other ratable evidence.  The service ROM measurements justified alternative rating under code 5271 (limitation of motion), but were consistent with the 10% criterion of “moderate” limitation.  Members agreed that a higher rating (20%) for “marked” limitation was not justified by the ROM evidence (33% - 50% reductions); thus, alternative rating under 5271 was not advantageous.  Given the absence of ankylosis, nonunion, or malunion, VASRD §4.71a offers no applicable code which would yield a rating higher than 10% for this case.  Additional rating of the ankles for instability is not permitted, nor was there objective evidence of significant instability in evidence.  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 adjudications of the bilateral ankle condition.  

Contended PEB Conditions:  Bilateral Plantar Fasciitis, Left Heel Bone Spur, and Hypertension.  The Board’s main charge was to assess the fairness of the PEB’s determinations that the above conditions were not unfitting.  In addition to congenital ankle varus, the CI also had congenital pes planus (prone to plantar fasciitis).  He was treated for plantar fasciitis (orthotics, night splint) during his earlier period of active duty; but, the only STR entry addressing the complaint for the active duty preceding the 2009 separation was a March 2009 presentation for “chronic bilateral foot pain EPTS [existed prior to service] needs MEB.”  There was no follow-up or any indication of clinical acuity or new treatment.  There was passing mention of a left heel spur in STR entries from the earlier active duty, but no probative evidence from the active duty period preceding the 2009 separation.  There was no demonstration of a calcaneal spur on any X-ray reports in evidence.  There were marginally elevated blood pressures documented in STR entries from the MEB period, but no directed clinical evaluations or evidence from pharmacy records that it was being treated.  The NARSUM documented only a history of the above conditions without elaboration, and all were forwarded to the MEB as meeting retention standards.  None of these conditions were profiled or implicated in the commander’s performance statement.  

Members agreed that there was no performance-based evidence indicating that any of the above conditions interfered with duty requirements to an extent that would have prohibited further military service.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determinations for the bilateral plantar fasciitis, left heel bone spur, and hypertension conditions; thus, they were not eligible for Service rating.

BOARD FINDINGS:  In the matter of the bilateral ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudications.  In the matter of the contended bilateral plantar fasciitis, left heel bone spur, and hypertension 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 20150615, 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

09 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002478 (PD201501408)

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