RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00536
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Construction Equipment Repairer, medically separated for “osteoarthritis, right ankle,” “right tronchanteric burtis,” and “left posterior tibial tendonitis,” rated 0% each with combined disability rating of 0%.  

CI CONTENTION:  A lengthy contention for unfitting conditions part of the complete submission 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070830	VARD - 20080605	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rt Ankle Osteoarthritis	5003	0%	Talotibial Degenerative Joint Disease (DJD), Medial Malleoulus, Right  Ankle, with Talar Neck Fracture, Status Post (S/P) ORIF Reduction	5010	10%	20080513	
Rt Trochanteric Bursitis	5019	0%	Iliopsoas Tendonitis and Bursitis, Rt Hip	5019	10%	20080513	
Lt Posterior Tibial Tendonitis	5024	0%	Tendonitis, Lt Posterior Tibia with OS Navicularis	5099-5024	10%	20080513	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Ankle Osteoarthritis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right ankle condition began in March 1997 after breaking his ankle.  He had open reduction and internal fixation (ORIF) surgery for a non-healing fracture.  Subsequent to his procedure he deployed to Iraq.  Upon return he experienced exacerbation of his symptoms.  During a physical therapy (PT) appointment on 25 June 2007, the CI complained of 4/10 pain to right ankle.  Examination showed painful motion with only mild limitations of motion and no ankyloses. 

The 31 July 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of ankle pain.  Physical examination showed a surgical scar on the right ankle and mild tenderness.  At the 13 May 2008 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported ankle pain.  Physical examination showed a full range of motion (ROM) with pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, coded 5003 (degenerative arthritis), citing the condition was “without ratable limitation of motion.”  The VA rated the right ankle condition 10%, coded 5010 (arthritis due to trauma), based on the C&P examination, citing painful motion.  

The panel noted no evidence of a moderate limitation of motion in the right ankle as required for the lowest rating of 10% per 5271, but there are repeated references to painful motion.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right ankle condition, coded 5003.  

Right Trochanteric Bursitis.  According to the STR and MEB NARSUM, the CI’s right hip condition began without incident or injury while deployed to Iraq in 2006.  During the 25 June 2007 PT appointment, 4 months prior to separation, the CI complained of 7/10 pain to the right hip.  Physical examination showed painful motion with flexion to 95 degrees (normal 120), extension to 15 degrees (normal 20), and abduction to 45 degrees (normal 45). 

The 31 July 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of hip pain.  Physical examination showed the right hip was tender at the inguinal crease.  The CI was able to cross legs, abduct beyond 10 degrees and toe out more than 15 degrees, all with pain. 

At the 13 May 2008 C&P examination, 5 months before separation, the CI reported hip pain.  Physical examination showed a normal gait and ROM measured in degrees was flexion to 125, extension to neutral, abduction to 45, and internal rotation to 40 indicating an ability to toe in greater than 15 degrees, and external rotation to 60 indicating an ability to cross his right leg.  All movements were accompanied by pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right trochanteric bursitis condition 0%, coded 5019 (bursitis), citing the condition was “without ratable limitation of motion.”  The VA rated the right hip condition 10%, coded 5019 (bursitis) based on the C&P examination, citing limitation of motion.  

The panel was unable to substantiate a ratable limitation of motion but noted consistent remarks about painful motion of the right hip.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right hip condition, coded 5019.  

Left Posterior Tibial Tendonitis.  According to the STR and MEB NARSUM, the CI’s left foot/ankle condition began without incident or injury when deployed to Iraq in 2006.  The 25 June 2007 PT evaluation documented motion limited by pain in the left ankle.  Physical examination showed full ROM in the left ankle with 20 degrees of dorsiflexion (normal 20) and 20 degrees of plantar flexion (normal 45).  

The 31 July 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of left ankle pain.  Physical examination showed tenderness between the navicular bone and the malleolus.   At the 13 May 2008 C&P examination, 5 months before separation, the CI reported medial left ankle pain.  The examiner noted a normal gait, and no effusion or instability.  Physical examination showed full ROM in the left ankle.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot/ankle condition 0%, coded 5024 (tenosynovitis), citing no compensable limitation of motion.  The VA rated the left foot/ankle condition 10%, analogously coded 5099-5024 (tenosynovitis) based on the C&P examination, citing painful motion.  

The panel finds no documentation of a decreased ROM in the ankle joint, and no documented dysfunction of the left leg or ankle.  There are references to painful motion in the PT notes and the VA rated the condition based on painful motion.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left foot/ankle condition, coded 5024.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 10%, coded 5003 IAW VASRD §4.171a.  In the matter of the right hip condition, the panel recommends a disability rating of 10%, coded 5019 IAW VASRD §4.171a.  In the matter of the left foot/ankle condition, the panel majority recommends a disability rating of 10%, coded 5024 IAW VASRD §4.73.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Osteoarthritis, Right Ankle	5003	10%	
Right Trochanteric Bursitis	5019	10%	
Left Posterior Tibial Tendonitis	5024	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170214, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006520  XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure