RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01944
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060903

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Wheeled Vehicle Mechanic, medically separated for “left ankle pain” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”  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 - 20060707	VARD - 20120503	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5099-5003	10%	Left Foot…with Tibial Tendonitis 	5279	10	20120214	
			LLE Peripheral Neuropathy a/w Left ankle Strain	8525	10%		
			Left Ankle Strain	5271	0%		
Mood Disorder Due to General Medical Condition	Not Unfitting	PTSD	9411	70%	20120112	
Substance Induced Mood Disorder						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Left Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left ankle during a training exercise in 1998.  In 1994, prior to enlistment, the CI had foot surgery, and the CI had post-injury surgery in 1998 with revision in March 2000, for posterior tibial tendon reattachment (this tendon, including its attached muscle, stabilizes and supports the arch of the foot).  Radiographic imaging studies showed ankle arthritis.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left ankle pain” for PEB adjudication.  

The 7 February 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of ankle joint pain without relief after having had injections.  The physical examination showed well-healed scars on the right and left side of the left ankle with no tenderness.  The range of motion (ROM) was dorsiflexion 5 degrees (normal 20) and plantar flexion 40 degrees (normal 45).  There was pain on heel raise and the CI had a significant amount of subtalar joint motion (laxity).  There was no VA examination in evidence proximate to separation.  The CI did not submit a VA compensation claim until 2010. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle pain 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  There was no VA placement for his left ankle condition proximate to separation.  However, remote from separation the VA did recognize a left foot condition for vocational rehabilitation purposes in 2010, and then additional left lower extremity ratings effective in 2010.  There was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  Limitation of ankle ROM did not support any rating higher than 10% (moderate limitation) under the VASRD diagnostic code for limitation of motion (5271).  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 left ankle pain condition.  

Contended PEB Conditions:  Mood Disorder due to General Medical Condition and Substance Induced Mood Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  According to the STR and psychiatrist’s NARSUM addendum, the CI developed depressive symptoms in response to his medical conditions, and had significant alcohol abuse and dependence.  The CI had sought mental health (MH) treatment for depressive symptoms beginning in July 2005 and he was engaged in pharmacotherapy which included Prozac, Zoloft, Wellbutrin, Seroquel and Ambien with minimal improvement.  The mental status examination was essentially normal and the examiner opined that the CI was not in danger to himself and was at low risk for suicide and homicide.  The MH treatment revealed that the CI’s depressive symptoms were primarily secondary to his physical condition and pain.  The CI was rated as mild under the social and industrial adaptability scale with an expectation of improved functioning and decrease in pain associated with his left ankle condition.  The CI had a global assessment of functioning of 65 (in the mild symptom range of 61-70).  The substance-induced mood disorder and alcohol abuse were profiled and judged to fail retention standards.  However, no mental health disorder or symptoms were implicated in the commander’s statement.  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 left ankle condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended mood disorder due to general medical condition and substance induced mood disorder, 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010702, 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,