RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01853
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080713

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Human Resources Specialist, medically separated for “chronic right ankle pain post fracture of distal fibula” with a disability rating of 20%.

CI CONTENTION:  The CI asks the Board to review the right ankle and the migraine headache conditions.  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 - 20080312	VARD - 20081211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain Post Fracture of Distal Fibula	5271	20%	Residuals, S/P Right Ankle Reconstruction	5271-5024	10%	20080508	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	50%	20080508	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain Post Fracture of Distal Fibula.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle pain began during basic training, was aggravated during advanced infantry training, and re-injured in September 2006 while swimming.  Her activities were modified, she was issued crutches, but her pain persisted.  X-rays were revealed soft tissue swelling (consistent with a sprain).  She was referred to orthopedics where ligamentous laxity was revealed and placed in an air cast.  She remained symptomatic and then underwent ankle reconstruction on 25 January 2007 with removal of a loose body.  She initially did well, but slipped on ice 7 weeks after surgery and reinjured her ankle.  She was placed in a cast, received local pain relief injections and continued rehabilitation.  An MRI on 29 March 2007 was significant only for post-operative changes.  Despite treatment, the CI was unable to return to full duty.

During an 11 September 2007 orthopedics examination, 10 months before separation, the CI was advised that she could either pursue further surgical intervention or MEB.  She elected the MEB.  The 18 October 2007 MEB physical therapy examination revealed repetitive range of motion (ROM) of dorsiflexion to 5 degrees (normal 20) and plantar flexion to 45 degrees (normal 45) with painful motion.

During the 23 October 2007 MEB NARSUM, 9 months before separation, the CI reported ongoing ankle pain aggravated by activity and weather changes.  Physical examination showed ROM of dorsiflexion to 20 degrees and plantar flexion to 30 degrees with painful motion.  Slight joint laxity was present and strength remained intact as well as sensation.  She was thought to have chronic pain refractory to treatment.  During the 22 February 2008 MEB NARSUM addendum, 5 months before separation, the examiner referenced the aforementioned MEB physical therapy ROM examination, and opined that the CI would have addition loss of motion of dorsiflexion less than 10 degrees and plantar flexion less than 30 degrees during flare ups.

At the 8 May 2008 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported pain with activity and her ankle gave way.  She was able to stand for 15-30 minutes and walk between a quarter to one mile.  She used a cane frequently and her gait was abnormal due to pain.  The ROM was dorsiflexion to 15 degrees and plantar flexion to 40 degrees with painful motion.  ROM did not decrease with repetition.  Her ankle was considered stable.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, coded 5271 (ankle, limited motion), citing “marked” limited ROM or loss of 50% ROM due to the CI’s lowered fatigue threshold with minimal use (especially during low ambient temperatures) which result in an inability to keep up with work requirements.  The VA rated the right ankle condition 10%, analogously coded 5024-5271 (tenosynovitis-ankle, limited motion), based on the C&P examination 3 months before separation, citing pain limited motion.

The panel agreed the MEB NARSUM and VA ROM examinations, most proximate to separation, support a “moderate” 10% rating for ankle limitation of motion; there was no additional ROM loss due to repetition.  The panel found no route to a higher 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 for the right ankle pain condition.

Contended PEB Conditions:  Migraine Headaches.  The panel’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.  It was judged to meet retention standards.  At the 08 May 2008 C&P examination the CI stated that her headache treatment was ineffective and she had a headache daily.  However, during the 09 May 2008 VA neurology examination, she stated that she had been headache free since starting Prozac other than a mild headache from cleaning house and poor sleep as she prepared to move to another state.  The panel found no record of emergency room visits in the 12 months prior to separation nor evidence that she had been placed on quarters in the months prior to separation.  She was admitted for 3 days in January 2008 for migraine heads.  The CI reported getting sick to her stomach and having migraine headaches due to her smoking cessation medication.  There was no performance-based evidence from the record that this contended condition 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 the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right ankle pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine headache condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There were 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 20150705, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007433, XXXXXXXXXXXXXXXXXX 

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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,					       
						      					
Enclosure