RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE: PD-2015-01663 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060504

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Health Care Specialist, medically separated for “right ankle pain” rated at 10%. “Bilateral tibial stress reactions,” were determined to have existed prior to service and were not rated.

CI CONTENTION:  Her conditions continue to worsen and impact her daily activities.  The CI’s 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 - 20060414		VARD – N/A	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%		
No VA examination in evidence	
Bilateral Tibial Stress Reactions	5022	--%			
Right Anterior Tibial Tendonitis	Not Unfitting			
Left Knee Patellar Tendonitis	Not Unfitting			
COMBINED RATING: 10%		COMBINED RATING OF ALL VA CONDITIONS: N/A	

ANALYSIS SUMMARY:

Chronic Right Ankle Pain. According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle pain condition began in January 2003 after turning inward. X-rays of the right ankle showed no bony abnormalities Symptoms were refractory to physical therapy, use of crutches, and various medications. At the MEB examination (recorded on DD Forms 2807-1 and 2808) dated 23 March 2006, 1 month prior to  separation,  the  examiner  reported  left  ankle  plantar  flexion  40  degrees  (normal  45),

dorsiflexion of 20 degrees (normal 20), inversion of 30 degrees and eversion of 0 degrees, and normal sensory, reflexes, motor strength and heel/toe walk. The examiner rated the pain as slight and intermittent (75% of the day.)

At the 23 March 2006 NARSUM, the CI reported symptoms were diffuse about the ankle and the CI was unable to carry equipment, patients, and felt unable to finish her training or pass an Army Physical Fitness Test (APFT.) Physical examination showed an antalgic gait favoring her right lower extremity. Examination of the right ankle showed no swelling or redness with an active range of motion (ROM) of dorsiflexion 10 degrees and plantar flexion 30 degrees. There was no evidence of instability or pain in the anterior ligaments or joint. A diagnosis of right ankle Grade I, inversion sprain stable was rendered. There was no VA Compensation and Pension examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic right ankle condition 10%, coded 5099-5003 (degenerative arthritis), citing the American Medical Association (AMA) Pain Rating as slight and constant (on MEB examination noted as slight and intermittent.). The panel noted the CI had an antalgic gait favoring the lower right extremity with a diagnosis of Grade I inversion ankle sprain and agreed the PEB likely assigned the 10% disability rating based on painful motion. Since ankle ankylosis was not present, a higher rating was not justified under the 5270 or 5272 codes. 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 chronic right ankle condition.

Contended PEB Conditions: Right anterior tibial tendonitis, left knee patellar tendonitis. The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting. None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards. There was no performance-based evidence from the record that any of the 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 any of the contended 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 recommends no change in the PEB adjudication. In the matter of the bilateral tibial stress reaction condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the right anterior tibial tendonitis, left knee patellar tendonitis contended conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting. There are 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 20150625, w/atchs Exhibit B. Service Treatment Record

AR20170012109, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely