RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01526
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, “Survival, Evasion, Resistance and Escape Operations Helper,” medically separated for “right tibia plateau fracture” and “right grade III ankle sprain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  “Pain is increasing in the right foot, ankle, knee and hip.  Range of motion in these joints is decreased and painful.”  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 - 20071031	VARD - 20080508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Tibia Plateau Fracture	5262	10%	Right Knee/Tibial Plateau Fracture	5260	0%	20080313	
Right Grade III Ankle Sprain	5271	10%	Right Ankle Sprain	5271	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Tibia Plateau Fracture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his right knee during a fall in early training (July 2007, 5 months before separation).  Magnetic resonance imaging (MRI) demonstrated a tibial plateau fracture (“medial ... small subchondral”).  Clinical STR entries documented recovery of a normal gait, and normal or modestly limited range of motion (ROM).  There was ample STR documentation of the absence of effusion, stability to stress testing, and negative signs of impingement; and, there were no entries to the contrary.  Surgery was not indicated; conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for MEB.  

The 12 September 2007 NARSUM examination, 3 months before separation, documented non-specific pain that prohibited continued training.  The physical examination recorded a normal gait, the absence of effusion, 4-plane stability to stress testing, and negative signs of impingement.  Measured ROM was flexion to 100 degrees (normal 140) and extension to 0 degrees (normal 0), without comment regarding painful motion.

A March 13 2008 VA Compensation and Pension (C&P) examination, 10 weeks after separation, documented knee pain rated 4/10 “elicited by physical activity.”  The physical examination recorded a normal gait, tenderness, the absence of effusion, 4-plane stability to stress testing, and negative signs of impingement.  Measured ROM was flexion to 140 degrees and extension to 0 degrees, specifying the absence of painful motion or degradation with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated 10%, coded 5262 (impairment of tibia and fibula).  The VA rated 0%, coded 5260 (limitation of flexion) citing the absence of ROM limitation or painful motion.  The PEB rating was consistent with the 5262 criterion of “slight” joint disability.  Code 5262 offers ratings of 20% for “moderate” and 30% for “severe” joint disability.  There was no minimum compensable ROM limitation and no persistent effusion with locking to support a rating higher than under any other code, and no evidence for (or PEB stipulation of) joint instability for separate rating.  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 of the right knee condition.

Right Ankle Sprain.  The CI injured his right ankle in the same incident as that for the knee.  The ankle remained painful, and an MRI demonstrated a ligamental injury (Grade III sprain, improving at that time).  There was ample STR documentation of normal ROM (dorsiflexion and plantar flexion), and no entries to the contrary.  There was no documentation in STR clinical entries of any ratable joint findings, to include painful motion.  Surgery was not indicated and conservative treatment did not result in sufficient improvement to allow unrestricted duty.  

The NARSUM documented non-specific pain contributing to the CI’s inability to continue with training.  The physical examination recorded “mild to moderate” tenderness, no effusion, and a stable joint.  The examiner specified the absence of pain in all planes of motion without a directed comment regarding ROM, and there were no goniometric ankle ROM measurements in evidence from the service file.  

The C&P examination (same as referenced above for the knee) documented ankle pain rated 3/10 “elicited by physical activity.”  The physical examination recorded the absence of tenderness, swelling, or instability.  Measured ROM was dorsiflexion to 20 degrees (normal 20) and plantar flexion to 45 degrees (normal 45), specifying the absence of painful motion or degradation with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated 10%, coded 5271 (limitation of motion).  The VA rated 0% under the same code, citing the absence of ROM limitation or painful motion as documented by the C&P examiner.  The PEB’s 10% rating and was consistent with the 5271 criterion of “moderate” limitation.  Code 5271 offers a maximum rating of 20% for “marked” limitation.  There was no evidence for “marked” ROM limitation to justify a higher rating under code 5271; and, there was no evidence for ankylosis, fracture, or other ratable finding to support a rating higher than 10% under any alternate code.

After due deliberation, considering all evidence and with deference to reasonable doubt, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the right ankle condition.

BOARD FINDINGS:  In the matter of the right tibial plateau fracture condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right ankle sprain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150620, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01526.

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,

XXXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings