RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01897
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070514

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Cryptologic Linguist, medically separated for “chronic left ankle pain” and “chronic low back pain,” rated 10% and 0%, respectively, with a combined  disability rating of 10%.  

CI CONTENTION:  Review 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 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 - 20070313	VARD - 20070827	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain 	5099-5003	10%	Status Post Left Ankle Surgery	5271	10%	20070123	
Chronic Low Back Pain	5299-5237	0%	No VA Placement		
Exercised Induced Asthma	Not Unfitting 	Asthma	6602	10%		
Hypothyroid	Not Unfitting	Hypothyroidism	7903	10%		
ITP	Not Unfitting	ITP	7799-7705	0%		
Rosacea	Not Unfitting	Rosacea With Ocular Rosacea	7899-7806	30%		
Seasonal Allergies	Not Unfitting	Allergic Rhinitis	6522	0%		
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	30%		
Plantar Fasciitis	Not Unfitting	Bilateral Pes Planus with Plantar Fasciitis	5299-5276	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent left ankle stabilization surgery in December 2005 with modified BrostrÖm repair.  The 27 November 2006 MEB NARSUM examination, 6 months prior to separation, noted complaints of pain with exertional activities, including walking and running, and prolonged standing or sitting.  Physical examination showed mild lateral malleolar and ligamentous tenderness.  Range of motion (ROM) testing, after repetition, showed left ankle dorsiflexion of 10 degrees (normal 20) and plantar flexion of 33 degrees (normal 45), limited by pain.  

At the 23 January 2007 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported constant 5/10 left ankle pain which radiated to the foot.  The pain occurred with physical activity, driving and sitting.  The CI wore an ankle brace, as needed, and reported monthly incapacitating episodes of 1 day.  Physical examination showed a normal gait, but there was left ankle tenderness.  The ROM study, after repetition, showed left ankle dorsiflexion of 15 degrees and plantar flexion of 30 degrees.  There was an additional 5 degrees of ankle limitation, primarily due to pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing slight and frequent pain IAW the US Army Physical Disability Agency pain policy.  The VA also rated the left ankle condition 10%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing moderate limitation of ankle motion.  

The NARSUM and VA examinations demonstrated painful motion supporting a 10% IAW §4.59.  All members agreed the limitation of motion did not rise to the level of “marked” for a 20% rating under 5271.  After due deliberation, considering all 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 left ankle condition.  

Chronic Low Back Pain.  According to the STR and MEB NARSUM, the CI’s back condition began in 1999 during basic training.  In May 2005, the CI presented for emergency care with complaints of lower back pain after falling down stairs.  Physical examination showed mild back discomfort with decreased thoracolumbar extension by 5 degrees (25 degrees), but there was full forward flexion.  

The MEB NARSUM examination noted CI complaints of back pain which prohibited prolonged sitting or standing.  Physical examination showed no significant focal tenderness, atrophy or fasciculation.  The CI had normal gait and spinal contour.  The examiner recorded thoracolumbar ROM measurements of 60 degrees of flexion (normal 90) and 165 degrees of combined ROM (normal 240), after repetition, and limited by pain.  

At the C&P examination the CI reported bilateral hip pain which radiated up the back and down the legs.  Physical examination showed radiating sciatic pain down both legs on movement, bilateral sacroiliac tenderness, and positive radicular testing bilaterally.  The examiner noted that there were not any “signs of intervertebral disc syndrome with chronic or permanent nerve root involvement.”  Thoracolumbar ROM measurements were flexion to 80 degrees and combined ROM of 160 degrees.  There was painful motion and an additional limitation of 5 degrees.  Radiographic studies of the lumbar spine demonstrated minimal arthritic changes at the lumbosacral junction.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, analogously coded 5299-5237 (lumbosacral strain), citing no neurologic abnormality and thoracolumbar ROM limited by pain.  The VA did not rate the back condition, noting the CI did not file a claim for it.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the VA examination, which most accurately reflected the CI’s back disability at separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 back condition, coded 5299-5237 

Contended PEB Conditions:  Asthma, Hypothyroid, Idiopathic Thrombocytopenia Purpura (ITP), Rosacea, Seasonal Allergies, Migraine Headaches and Plantar Fasciitis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  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 there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5299-5237 IAW VASRD §4.71a.  In the matter of the contended asthma, hypothyroid, ITP, rosacea, allergy, migraine and plantar fasciitis conditions, the panel 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 recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Ankle Pain	5099-5003	10%	
Chronic Low Back Pain	5299-5237 	10%	
COMBINED	20%	

AR20190007024, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

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