RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04653
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060913

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “osteochondritis dissecans left ankle” and “left wrist posttraumatic arthritis,” rated 0% each, with a combined disability rating of 0%.  

CI CONTENTION:  “Residuals of left wrist fracture with surgical repair and scar, left ankle Achilles tendonitis and osteochondral cyst.  Left heel numbness, degenerative arthritis left knee, degenerative arthritis right knee.”  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 - 20060717	VARD - 20070122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteochondritis Dissecans Left Ankle	5099-5003	0%	Left Ankle Achilles Tendonitis and Osteochondral Cyst	5271	10%	20060720	
Left Wrist Posttraumatic Arthritis	5010	0%	Residuals of Left Wrist Fracture with Surgical Repair and Scar	5215	10%	20060720	
Patellofemoral Syndrome with Arthritis Both Knees	Not Unfitting	Degenerative Arthritis Right Knee	5003-5260	0%	20060720	
		Degenerative Arthritis Left Knee	5003-5260	0%	20060720	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Ankle Osteochondritis Dissecans.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left ankle pain started in 2001 after he jumped out of a tactical vehicle and landed awkwardly.  After 2 years of intermittent profiles, the pain continued, and during a deployment he reinjured his ankle while kicking in doors during a mission.  An MRI and X-rays showed a talar dome cyst with osteochondritis dissecans.  

During the 25 April 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported right ankle pain.  Physical examination showed left ankle range of motion (ROM) with dorsiflexion of 5 degrees (normal 20) and plantar flexion of 40 degrees (normal 45).  The 11 July 2006 MEB NARSUM examination, 2 months before separation, noted complaints of chronic left ankle pain which limited running, jumping, climbing, squatting and performing normal daily activities.  Physical examination showed left ankle tenderness with dorsiflexion of 5 degrees and plantar flexion of 40 degrees.  

At the 20 July 2006 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI reported constant left ankle pain rated at 7/10.  Physical examination revealed left ankle dorsiflexion of 16 degrees and plantar flexion of 42 degrees, with painful motion.  The joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, analogously as 5003 (arthritis, degenerative), citing no compensable limitation of motion.  The VA rated the left ankle condition 10%, coded 5271 (ankle, limited motion), based on the C&P examination, citing painful motion.  Members agreed that the there was no limitation of motion that supported a rating under diagnostic code 5271, however there was evidence of painful motion causing functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 recommends a disability rating of 10% for the left ankle condition, analogously coded 5099-5003.  

Left Wrist Posttraumatic Arthritis.  According to the STR and MEB NARSUM, the CI injured his left wrist after falling down the stairs in his barracks in mid-2000, and underwent surgery for a scaphoid fracture followed by post-surgery casting for nearly 8 months.  Upon completing rehabilitation, he deployed in 2003, however the left wrist continued to bother him intermittently with swelling and osteoarthritis changes, as noted on X-rays.  

During the MEB examination, the CI had no specific wrist complaint.  Left wrist ROM, measured in degrees, revealed dorsiflexion of 50 (normal 70), palmar flexion of 45 (normal 80), ulnar deviation of 35 (normal 45), and radial deviation of 10 (normal 20).  The MEB NARSUM examination noted complaints of intermittent left wrist pain worsened by activity.  Physical examination showed left wrist tenderness, and ROM, in degrees, revealed dorsiflexion of 50, palmar flexion of 45, ulnar deviation of 35, and radial deviation of 10.  

At the C&P examination, the CI reported constant left wrist pain rated at 1-7/10.  Measured ROM, in degrees, was: dorsiflexion of 70, palmar flexion of 80, ulnar deviation of 40, with pain, and radial deviation of 15, with pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 0%, coded 5010 (radius and ulna, nonunion of), citing no limitation of functional activities.  The VA rated the left wrist condition 10%, coded 5215 (wrist, limitation of motion), based on the C&P examination, citing painful motion.  Members agreed there was no wrist ankylosis or limitation of motion to justify rating under codes 5214 or 5215, however, there was evidence of painful motion with functional loss to support a 10% rating (based on §4.59, §4.40 and §4.45).  There was no paralysis, muscle weakness (grip strength) or muscle atrophy noted to warrant a rating under code 8515, and alternative VASRD wrist and analogous codes all were not applicable and not advantageous to rating.  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 wrist condition, analogously coded 5099-5003.  

Contended PEB Condition:  Patellofemoral Syndrome with Arthritis Both Knees.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The contended conditions were profiled and implicated in the commander’s statement, but did not fail retention standards according to the same orthopedic surgeon that found the two above conditions unfit.  The profile specifically stated that the left ankle and wrist conditions were the primary cause for the CI’s limitations, and listed the knees as being “bothered with activity” and specifically coded L2.  The VA C&P examination also noted normal bilateral knee ROM without pain.  The panel therefore found there 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 left ankle condition, the panel recommends a disability rating of 10%, analogously coded 5099-5003 IAW VASRD §4.71a.  In the matter of the left wrist condition, the panel recommends a disability rating of 10%, analogously coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended bilateral patellofemoral syndrome with arthritis, 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	
Osteochondritis Dissecans Left Ankle	5099-5003	10%	
Left Wrist Posttraumatic Arthritis	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

[AR NUMBER], 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.

Enclosure