RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03819
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20081217

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “left ankle pain” with a disability rating of 10%. “Depressive disorder not otherwise specified [NOS]” was determined to have existed prior to service (EPTS) and was not rated.

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 - 20080904	VARD - 20090408	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5299-
5024	10%	Left Foot Peroneal Tendonitis with Subluxation and Planter Fasciitis	5099-5024	10%	20090107	
Depressive Disorder NOS	9435	EPTS	Major Depressive Disorder claimed as ADHD, Depressive Disorder and Anxiety Disorder	
9434	
NSC	
20090113	
Attention Deficit Hyperactiity Disorder (ADHD) NOS	Not Compensable					
Right Foot Pain	Not Unfitting	Right Foot Peroneal Tendonitis with Plantar Fasciitis	5099-5024	10%	20090107	
Decreased Hearing Bilateral	Not Unfitting	Bilateral Hearing Loss	6100	NSC	20090107	
Tinnitus	Not Unfitting	Tinnitus Left Ear	6260	10%	20081218	
Chronic Diarrhea	Not Unfitting	Chronic Diarrhea	7319	NSC	20090107	
Personality Disorder NOS	Not Compensable	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Left Ankle Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left ankle pain begin in August 2006 when the CI fell in a ditch and sprained his left ankle. The left foot was in a CAM walker for multiple months; conservative therapy did not reduce the CI’s pain symptoms. He was diagnosed with left peroneal tendinitis in 2007, and no surgery or invasion procedures were planned.

During 13 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI complained of left foot/ankle tendonitis with use of ankle braces and insoles. Physical examination showed left lateral foot mild tenderness without edema or ecchymosis. Range of motion (ROM) was “full.” The 7 August 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued left ankle pain, increased with activity. Physical examination showed the left ankle with no edema, open lesions, ecchymosis, or erythema. Sensation was intact and muscle strength was normal. Tenderness was noted to the peroneal tendons of the lateral left foot and ankle, and the CI demonstrated subluxation of the left peroneal tendons. There was no tenderness or crepitus with ROM of the ankle or foot. ROM taken with a goniometer “averaged” dorsiflexion at 20 degrees (normal) and plantar flexion at 45 degrees (normal).  Painful motion was not discussed.

At the 7 January 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported pain at rest in the left ankle and foot, with exacerbations with activity or stress. He also reported weakness, stiffness, swelling, giving way, locking, and lack of endurance. Physical examination showed a normal gait. The left ankle showed tenderness at the peroneal tendon at the lateral malleolus, with slight subluxation. There was no deformity, edema, effusion, weakness, redness, heat, or guarding of movement. ROM showed dorsiflexion of 20 degrees and plantar flexion of 45 degrees. ROM was not limited by pain, fatigue, weakness, lack of endurance or incoordination after repetition. There was left foot plantar surface tenderness.  X-rays were negative.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 10%, coded 5099-5003 (degenerative arthritis), citing evidence of painful motion. The VA also rated the left ankle condition 10%, coded 5099-5024 (tenosynovitis), based on the C&P examination, citing plantar tenderness of the left foot. There was no pes planus, pes cavus, hammer toes, Morton’s Metatarsalgia, hallux valgus or hallux rigidus.

There was no limitation of ankle ROM that supported a rating under the VASRD diagnostic code for limitation of motion (5271). However, 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. The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating. 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.

Depressive Disorder. According to the STR and MEB NARSUM, the CI reported that from the ages of 12 to 16 he was treated with medication for depression including one or two hospitalizations (6 months) following the murder of his father. He had had episodes of self-destructive behavior and was in an alternative school for misconduct, before ending high school in the 11th grade. He stopped talking his medication at the age of 16 with no other complaints. The CI’s entry history and physical showed he denied any mental health history.

The CI had a recurrence of the depressive symptoms around Christmas 2007 secondary to the separation from his family.       In the spring of 2008, his depression symptoms worsened due to

problems associated with his former unit. The CI reported improvement after being assigned to the Warrior Transition Battalion.

During MEB examination, the CI complained of panic, anxiety, depression, and being seen monthly for check-ups. He was on two psychoactive medications. Tough the psychiatric block  40 was marked as normal the examiner requested a psychiatric consult. The 11 July 2008 psychiatry MEB consultation, detailed the above history and military history including stating the CI “continued to demonstrate his longstanding schizotypal and antisocial personality characteristics. … and ongoing issues with his personality disorder interfering …” A mental status examination (MSE) showed his mood was described as “I’m O.K.,” with a mood-incongruent, constricted/guarded affect with limited range and reactivity; he endorsed active belief in fantasy, magical thinking with paranoid ideation and unusual perceptual experiences; insight was extremely limited. Impulse control was good. The Axis I diagnosis was depressive disorder NOS, with psychotic features as manifested by subjective unhappiness, paranoid thinking and hallucinatory experience over time, with escalations under duress. The psychiatrist stated “this condition existed prior to initial entry into the Army,” and was not permanently aggravated by service. The psychiatrist also diagnosed personality disorder NOS, with prominent schizotypal and antisocial features. The Global Assessment of Functioning score was 51-60, moderate symptoms with mild-moderate impairment for further military duty, and for social and vocational adaptability.  The CI failed medical retention standards.

The MEB NARSUM examination, 4 months prior to separation, noted complaints of a depressed mood, no feelings of guilt, decreased appetite and poor sleep. The CI denied suicidal or homicidal ideations, was seeing a psychiatrist once a month and a psychologist twice a month, and remained stable for 6 months. The MSE was not substantively different from the psychiatrist’s MEB consult (above). The MEB and PEB indicated the mental health diagnosis was EPTS without permanent service aggravation (PSA). The later VA examination and rating also determined the CI’s MH condition was EPTS, not PSA, and was therefore not service connected. 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 (EPTS, not PSA, unfitting, and not compensable) for the MH condition.

Contended PEB Conditions: Right Foot Pain, Decreased Hearing Bilateral, Tinnitus, Chronic Diarrhea, ADHD, and Personality Disorder NOS. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting, or not compensable. ADHD and personality disorder are conditions not constituting a physical disability and are not compensable IAW DoDI 1332.38. None of the other conditions were profiled or implicated in the commander’s statement and none failed retention standards. There was no performance-based evidence from the record that any of the potentially compensable 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 or compensability 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 depressive disorder condition, the panel agrees it cannot recommend it for additional disability rating. In the matter of the contended right foot, decreased hearing, tinnitus, and chronic diarrhea conditions, the panel recommends no change from the PEB determinations as not unfitting. In the matter of the contended attention deficit hyperactivity disorder and personality disorder conditions, the panel recommends no change from the PEB determinations as not compensable. There are no other conditions  within  the  panel’s  scope  of  review  for  consideration.     Therefore,  the       panel

recommends no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

	PD-2017-03819

AR20190011604, XXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	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.

	PD-2017-03819