RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01777
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050901

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “right ankle” and “mild pes planus deformity,” rated 0% and ---% (existed prior to service (EPTS), not permanently service aggravated) respectively, with a combined disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 - 20040903	VARD - 20150304	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Injury	5099-5003	0%	Right Ankle Tendonitis	5271-5024	10%	20150212	
Mild Pes Planus Deformity (Bilateral)	5299-5278	EPTS	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Ankle Injury.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI reported sustaining a right ankle injury prior to service and reinjured it while in service.  At the podiatry clinic entry on 14 Jun 2005, 3 months prior to separation, the CI was evaluated for a painful, swollen and bruised right ankle after falling and twisting the ankle.  He indicated a long history of ankle pain.  Physical examination showed decreased range of motion (ROM), weakness, no laxity, no swelling and no deformity to the right ankle.  An antalgic gait was observed and peripheral sensation was normal.  A right ankle computerized tomography scan revealed osteochondritis dissecans.  The MEB NARSUM examination on 22 July 2005, 2 months prior to separation, noted complaints of pain when climbing over aircraft, walking and during physical activity.  Physical examination showed no tenderness to palpation and no edema; however, the examiner did indicate reduced active ROM (although none was formally recorded) and the CI stated his ankle was “weak”. The MEB forwarded “osteochondritis dissecans, right ankle” for PEB adjudication.

There was no VA examination performed within 12 month of separation for Board consideration; the VA examination was accomplished 10 years after separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, coded 5099-5003 (degenerative arthritis), citing the condition existed prior to service; however, permanent service aggravation was granted.  The VA rated the right ankle condition 10% effective 01 December 2013, coded 5271-5024 (ankle, limited motion – tenosynovitis), based on a C&P examination 10 years after separation.

The Board considered whether a higher rating was supported under other diagnostic code options.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  The ankle limitation of motion at the MEB examination was slight (examiner indicated decreased ROM) and did not approach the moderate limitation required for a 10% rating under diagnostic code 5271 for limitation of ankle motion.  The Board noted the underlying cause for the ankle impairment was residuals of a fracture of the tibia and considered rating using the VASRD diagnostic code 5262 (impairment of the tibia, fibula and ankle); however, there was no malunion or nonunion to be able to assign a rating.  Board members agreed there was no limitation of ankle motion to support a moderate 10% rating; however, there was sufficient STR evidence of pain with use which met criteria for a 10% rating IAW §4.59 and §4.40 (painful motion and functional loss).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right ankle condition, coded 5099-5003.

Contended PEB Condition:  Mild Pes Cavus Deformity (Bilateral).  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  The CI reported right ankle pain consistently; however, the right foot pain did not become an issue until after entry into the Disability Evaluation System (DES).  Pes cavus is a congenital condition that is not compensable or pensionable IAW VASRD §4.9 and §4.57 (congenital or developmental defects, and static foot deformities) and was not permanently service aggravated.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended pes cavus deformity condition; the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Ankle Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150628, 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, AR20170001954 (PD201501777)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA