RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2016-00186
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20050228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Automated Logistical Specialist, medically separated for “chronic bilateral ankle pain…” with a disability rating of 10%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20041112	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Ankle Pain Secondary to Osteoarthritis Resulting after Surgeries for Bilateral Calcaneo-Navicular Conditions	5099-5003	10%	No VA Exam in Evidence	
Mild HF Hearing Loss	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Bilateral Ankle Pain.  The PEB combined the right and left ankle conditions under a single service disability rating, coded 5099-5003 (analogous to degenerative arthritis) and rated 10% with application of the US Army Physical Disability Agency (USAPDA) pain policy AR 635-40 B24.f.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel also noted that “bundling,” the combining of two or more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the right and left ankle conditions are presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgery (subtalar fusion) on the right ankle in October 1998 and on the left ankle in December 1999 to correct inappropriately joined bones (calcaneonavicular coalitions) in each of his feet.  Radiographic imaging (CT) of the right ankle in April 2001 documented osteoarthritis.  Further imaging (X-rays) of the bilateral feet in June 2004 documented evidence of prior fusions and no other findings.  

At the 2 August 2004 orthopedic visit, 7 months prior to separation, the CI reported chronic bilateral foot pain.  On physical examination the right ankle showed tenderness of the anteromedial ankle, with “good” range of motion (ROM).  The left foot was reported to have tenderness laterally with “good” ROM.  The neurovascular functioning of each foot was reported as being intact, and neither foot was swollen.  

During the 6 August 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported pain and limited motion in both ankles.  Physical examination showed “bilateral foot pain.”  The 24 September 2004 MEB NARSUM, 5 months prior to separation, noted use of orthotics and complaints of chronic bilateral ankle pain which limited walking, running, jumping, prolonged standing, or heavy lifting.  Upo examination, the right ankle was tender medially and had dorsiflexion to 10 degrees (normal 20) and plantar flexion to 45 degrees (normal 45).  The left ankle was also tender anteromedially and showed normal dorsiflexion and plantar flexion.  Neither ankle had swelling.  The bilateral feet showed “mild pes planus” without tenderness of the plantar fascia or calcaneus (heels).  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  As elaborated above, the PEB rated the bilateral ankle condition 10%, coded 5099-5003, citing the USAPDA pain policy.  

The panel first considered whether the right ankle condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Both ankles were profiled, implicated in the NARSUM, forwarded by the MEB and adjudicated as unfitting by the PEB.  All notes referenced the bilateral condition and both ankles required surgery.  Members agreed that both the right and left ankle conditions were reasonably justified as separately unfitting and that they met VASRD §4.71a criteria for separate rating.  Accordingly, each could be afforded separate service disability ratings.  

Regarding the right ankle, there was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However there was radiographic evidence of osteoarthritis, limitation of motion and evidence of painful motion causing functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45), coded 5003-5271.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  

Regarding the left ankle, although both ankles required surgery, there was no limitation of dorsiflexion or plantar flexion on the left that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  The left ankle had no radiographic evidence of arthritis and no evidence of painful motion to support a 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bilateral ankle condition.  

Contended PEB Condition:  Mild High Frequency Hearing Loss.  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, 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.  After due deliberation, the panel concluded 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 chronic bilateral ankle pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended high frequency hearing loss condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160403 w/atchs
Exhibit B.  Service Treatment Record

AR20170014681, 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,					      
						      					
Enclosure