RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02360
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E2, Signal Support Systems Specialists, medically separated for “chronic pain, right foot and ankle, with chondromalacia right ankle” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The 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 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 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 - 20050110	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Foot and Ankle, with Chondromalacia Right Ankle	5099-5003	10%	No VA Disability Claim Filed	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:

Right Foot and Ankle.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot condition began on 12 July 2002 during basic combat training.  He was treated with a Cam Walker where he healed and developed a painful ankle that required arthroscopic debridement with micro fracture chondroplasty of an osteochondritis dissecans.  The MEB forwarded right foot and ankle pain and chondromalacia for PEB adjudication.  A medical record report from physical therapy and podiatry dated 15 July 2002 noted that the CI had a non-displaced fracture of the 4th metatarsal on the right foot.  A commander’s statement dated 01 October 2004 stated the CI was not able to perform his duties since his injury.  The MEB NARSUM examination on 05 November 2004, 4 months prior to separation, noted complaints of right foot and ankle pain with right ankle chondromalacia.  Physical examination showed tenderness to palpation over the third metatarsal dorsally and a Tinel’s sign (sensation of tingling or “pins and needles” when tapped) over the medial portal scar.  Range of motion displayed 25 degrees dorsiflexion (normal 20), 50 degrees plantar flexion (normal 45) and no pain at the limits.  The examiner noted negative anterior drawer and talar tilt tests. There was no VA disability claim in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot and ankle under a single disability 10%, analogously coded 5009-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy rated for slight/frequent pain.  Although VARSD §4.71a permits combined ratings of two or more joints under 5003, it allows separate ratings for separately compensable joints.  If supported under VASRD §4.71a, separate ratings for PEB foot and ankle joint adjudications may be recommended by the Board if members determine each joint is reasonably justified as separately unfitting.  Although the disability associated with the right foot pain was greater than the right ankle pain, both were profiled, implicated by the NARSUM, and considered to fail retention standards.  Members agreed the clinical and fitness performance evidence the disability associated exclusively with the right foot could not be isolated from the right ankle; therefore, supports that each could be reasonably justified as separately unfitting.  The Board noted the NARSUM examination documented full, painless ankle motion and right foot tenderness to palpation.  Board member agreed the absence of limitation of motion and radiographic evidence of healed foot fractures and ankle bony pathology supports a 10% rating under 5003.  There evidence did not support separate ankle ratings for painful motion.  The Board also considered a rating under 5279 (metatarsalgia); however, this would not have resulted in a higher than 10% combined rating.  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 foot and ankle condition.  

BOARD FINDINGS:  In the matter of the right foot and ankle condition and IAW VASRD §4.59, the Board unanimously recommends no change in the PEB adjudication.  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 June 2015, w/atchs
Exhibit B.  Service Treatment Record

AR20170004616, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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