RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03957
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “chronic bilateral ankle pain” with a disability rating of 20%.

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 - 20090701	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Ankle Pain	5099-5003	10%	Degenerative Joint Disease (DJD), Right Ankle 	5010-5271	10%	20081029	
		10%	DJD, Left Ankle	5010-5271	10%		
Adjustment Disorder with Anxiety and Depressed Mood	Not Unfitting	Adjustment Disorder with Anxious Features	9413	10%	20081028	
Gastroesophageal Reflux Disease (GERD)		GERD	7346	0%	20081029	
Chronic Thoracolumbar Back Pain		Lower Back Muscle Strain	5237	10%		
Bilateral Pes Cavus Deformity		Bilateral Pes Cavus with Plantar Fasciitis	5278	10%		
Peripheral Edema 		Varicose Veins	7120	NSC		
Hyperlipidemia		No VA Placement	
Right Lateral Epicondylitis		Mild Carpal Tunnel Syndrome, Right Wrist	8515	0%	20081028	
Paresthesias Left Hand		Status Post Carpal Tunnel Release, Left Wrist	8515	10%		
Erectile Dysfunction		Erectile Dysfunction	7522	NSC		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	
ANALYSIS SUMMARY:  

Chronic Bilateral Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bilateral ankle condition that began in January 2004 without precipitating injury, worsened over time and was unresponsive to recommended conservative treatment.  Remote (2004) and recent (2007) radiographs revealed osteochondral (cartilaginous overlay of bone) lesions in both talar domes (mid-superior ankle area).  

At the 13 March 2008 MEB NARSUM examination, 9 months prior to separation, the CI’s chief complaint was listed as “arthritis in both ankles.”  His physical examination (PE) revealed decreased ankle dorsiflexion to 10 degrees on the right and 8 degrees on the left (normal 20).  Bilateral ankle plantar flexion was normal.  Painful motion was evident by the CI’s reaction of facial grimacing upon left ankle joint movement.    

At the 29 October 2008 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI reported that running and ruck marching aggravated his bilateral ankle pain.  Additionally, he endorsed symptoms of pain, stiffness, weakness, and giving way in both ankles.  Painful ankle flare-ups were described as occurring on a weekly basis with “mild” intensity on the right lasting for 10 minutes and “moderate” intensity on the left lasting for 15 minutes.  His PE revealed a normal gait and heel/toe walk.  Tenderness was present about both ankles and painful motion occurred with left dorsiflexion.  Specific ROM noted decreased plantar flexion at 40 degrees (normal 45) bilaterally and decreased dorsiflexion to 15 degrees on the left.  Right ankle dorsiflexion was normal.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each ankle condition 10% for a combined 20%, analogously coded 5099-5003 (arthritis, degenerative), citing VASRD §4.59 (painful motion).  The VA also rated each ankle 10%, dual coded 5010-5271 (arthritis, due to trauma, limited motion of ankle) based on the C&P examination, citing moderate limited motion.  

Panel members first agreed that the greatest probative value be apportioned to the VA examination due to the closeness to separation.  Members then considered if VASRD code 5271 (ankle, limited motion) was appropriate for either ankle and concluded that the limited and near-normal ROM of either ankle would not be considered or supported at a “marked” (20%) impairment level.  Additionally, the evidence of maintaining the ability to perform a normal heel/toe walk would support normal or very near normal ankle ROM.  Such heel/toe walk evidence would also call to question even a “moderate” impairment rating for 10% to either ankle.  Therefore, members agreed that code 5271 was not best represented by the stated condition but that with abnormal radiographs, painful motion and/or tenderness, the PEB’s combined 20% under VASRD §4.59 and coded analogously to 5003 was appropriate.  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 bilateral ankle condition.  

Contended PEB Conditions:  Adjustment Disorder with Anxiety and Depressed Mood, GERD, Thoracolumbar Back Pain, Bilateral Pes Cavus Deformity, Peripheral Edema, Hyperlipidemia, Right Lateral Epicondylitis, Left Hand Paresthesias, and Erectile Dysfunction.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement and did not fail retention standards.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  
BOARD FINDINGS:  In the matter of the bilateral ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder with anxiety and depressed mood, GERD, thoracolumbar back pain, bilateral pes cavus deformity, peripheral edema, hyperlipidemia, right lateral epicondylitis, left hand paresthesias, and erectile dysfunction, 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

AR20180015896, 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.