RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01696
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060607

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Light Wheel Vehicle Mechanic, medically separated for “chronic right ankle pain, status post Brostrӧm repair for an unstable, frequently sprained ankle,” with a disability rating of 10%.

CI CONTENTION:  The CI contends all conditions in his application.  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 - 20060509	VARD – 20070403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain…	8623	10%	Right Ankle, S/P Brostrӧm Procedure	5271	NSC	STR	
Mild Intermittent HAs	Not Unfitting	Mild Intermittent Headaches	8100	NSC		
Intermittent L Wrist Pain…		Left Wrist Pain	5215	NSC		
Mild Dyslipidemia…		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  --%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had multiple right ankle sprains and was ultimately taken to surgery for ankle laxity.  A Brostrӧm procedure was performed on 25 July 2005 with a stable ankle post-operatively.  However, he did have continued pain despite rehabilitation.  On 10 January 2006, he was noted to have full range of motion (ROM) and a stable ankle.  He did note tender over the scar though.  In orthopedics on 7 February 2006, it was noted that the nerve pain at the incision site precluded performance of his duties.  On examination, dorsiflexion (toes up) was reduced on the right compared to the left, but was still within normal limits.  Plantar flexion (toes down) was 30 degrees; reduced from the left side recorded as 40 degrees.  Both were less than the VA normal 45 degree value.  He was noted to have abnormal sensation at the site of the incision and a percussion test to evaluate for local nerve damage was positive (Tinel).  He was diagnosed with joint pain (arthralgia) from the surgery with a neuroma (an abnormal growth of nerve tissue) of the superficial peroneal nerve.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right ankle and foot pain and paresthesias, status post Brostrӧm surgical procedure with superficial peroneal nerve neuroma” for PEB adjudication.  

At the time of a primary care clinic appointment on 10 January 2006, 5 months prior to separation, the CI reported worsened ankle pain for the 5 days previous to the appointment.  The physical examiner noted the CI had full range of motion (ROM) without swelling and the ankle showed full stability.  The 7 February 2006 orthopedic MEB physical examination noted dorsiflexion of 20 degrees (normal 20) and plantar flexion of 30 degrees (normal 45).  The CI displayed full motor function and full sensation in the deep peroneal, superficial peroneal with some dysesthesia in the sural nerve distribution and superficial branch of the peroneal nerve.  The MEB NARSUM, dated 11 April 2006, referenced the above examination, but also recorded that the CI walked with a limp.  The CI failed to report to his scheduled VA Compensation and Pension examination.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 8623 (anterior tibial nerve (deep peroneal) neuritis), citing numbness and paresthesia on lateral aspect of foot and ankle due to neuroma.  The VA did not service connect the right ankle condition, coded 5271 (limited motion of ankle).  The limitation in plantar flexion supported a 10% rating under the VASRD diagnostic code for limitation of motion (5271).  The Board concurred that a 10% rating was also supported by functional loss (§4.40, §4.45, §4.59) due to pain and was appropriate as adjudicated by the PEB.  The neuroma also supported a 10% for painful motion.  While more than one VASRD code describes the clinical impairment in this case, only one can be supported by the use of painful and limited motion without violation of VASRD §4.14 (avoidance of pyramiding).  A mechanical limitation of motion was not recorded and the ROM was noted to be full on some examinations, consistent with a limitation from pain.  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 adjudication for the right ankle condition.  

Contended PEB Conditions:  Mild Intermittent Headaches, Intermittent Left Wrist Pain and Stiffness, Mild Dyslipidemia with Low HDL.  The Board’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, 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 Board 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 §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended mild intermittent headaches, intermittent left wrist pain and stiffness, and mild dyslipidemia with low HDL 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

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001932 (PD201501696)

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