RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05048
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Parachute Rigger, medically separated for “chronic bilateral ankle pain,” rated 10% each ankle, with a combined disability rating of 20%.   

CI CONTENTION:  The CI listed left and right ankles, back, shoulder and hands.  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 - 20090827	VARD - 20100604	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Ankle Pain	5099-5003	10%	Surgical Residuals, Left Ankle 	5299-5271	0%	20100312	
		10%	Surgical Residuals, Right Ankle	5299-5271	0%	20100312	
Arthralgia, Left Shoulder	Not Unfitting	Surgical Residuals, Left Shoulder	5299-5203	10%	20100312	
Mechanical Back Pain	Not Unfitting	Lumbar Strain and Herniated Disc	5243	10%	20100312	
Bilateral Ulnar Sensory Neuropathy	Not Unfitting	Left Elbow Ulnar Neuropathy	8699-8616	0%	20100312	
		Right Elbow Ulnar Neuropathy 	8699-8616	0%	20100312	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bilateral Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI began experiencing bilateral ankle pain in 2006, attributed to parachute jumps.  An MRI showed cartilage damage (osteochondral) and tendon injuries (partial tears of posterior tibial and peroneus brevis) of the right ankle and an osteochondral defect of the left ankle.  He underwent debridement and reconstruction of the right ankle in July 2006, followed by arthroscopic debridement of the left ankle in January 2007.  Post-operative STR entries for both ankles documented the absence of surgical complications and improving range of motion (ROM).  After surgical recovery, there was no STR evidence for minimum compensable ROM limitation, gait disturbance, joint instability or impingement, or other VASRD-ratable findings for either ankle.  

The 28 April 2009 MEB NARSUM examination, 8 months prior to separation, documented persistent ankle pain rated 4/10 on the right and 5/10 on the left, with no instability, exacerbated by impact activities, running and prolonged walking.  The physical examination (all findings bilateral) recorded a normal gait, no swelling, tenderness (“over both anterior talofibular ligaments”), stability to drawer testing and normal strength.  The NARSUM referenced formal ROM measurements by physical therapy (PT) conducted three weeks later (19 May).  The PT examiner charted bilateral dorsiflexion to 20 degrees (normal) and bilateral plantar flexion to 40 degrees (normal 45), specifying the absence of painful motion or ROM degradation with repetition.

At the 12 March 2010 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported “daily” stiffness and pain, with no instability, that was characterized as “mild” for the right ankle and “moderate” for the left.  The examiner noted functional limitations with standing (1-2 hours) and walking (one mile), but opined that the CI “can perform whatever active or sedentary work he wishes.”  He was employed full time with the local police department, and had been physically cleared to enter the training academy.  The physical examination (all findings bilateral) recorded a normal gait, normal alignment, no swelling, no instability and normal strength.  Measured bilateral ankle ROM was normal in all planes, specifying the absence of painful motion or ROM degradation with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each ankle 10%, coded 5099-5003 (analogous to degenerative arthritis), citing functional loss with applicable VASRD references.  The VA rated each ankle 0%, coded 5299-5271 (analogous to limitation of motion), citing the absence of any compensable findings from the C&P evidence.  Given the above ROM evidence and the absence of ankylosis or fracture, there is no other applicable joint code which would yield a rating higher than the PEB’s 10% for either ankle.  Members agreed that more favorable analogous rating for functional loss (via 5299-5283 or 5299-5262) was not justified by the disability in evidence.  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 right and left ankle conditions.  

Contended PEB Condition:  Left Shoulder.  The CI experienced an atraumatic onset of left (non-dominant) shoulder pain in October 2007 that was diagnosed as tendinitis (supraspinatus and infraspinatus without tear by MRI).  There was documentation in STR clinical entries of normal ROM with painful motion but no other acute findings, and there was no evidence of an injury or other acute exacerbation after onset.  The NARSUM documented pain rated 5/10 without specifying any functional limitations specific to the upper extremities.  The only positive physical finding was tenderness.  Measured ROM by PT was normal (forward flexion and abduction to 180 degrees each) with painful motion on abduction greater than 90 degrees.  The condition was judged to meet retention standards.  There was no profile over the 2-year period after onset until a U2 was added to the permanent profile on 19 June 2009, although the commander’s performance statement indicated the CI’s shoulder pain interfered with his job as a parachute rigger.

The PEB fitness adjudication was predicated on the above evidence, but the CI underwent arthroscopic debridement of the shoulder on 18 September 2009 (3 months before separation).  An orthopedic post-operative note of 1 October (11 weeks before separation) documented the absence of any complications and the CI’s report that his pain had improved over the pre-operative level.  A PT note two weeks later documented that the CI was “doing well” and recorded forward flexion to 150 degrees with “slight pain end-range all motions.”  The C&P examination (3 months post-separation as above) documented “occasional, mild” pain that had “improved since the surgery,” with no occupational interference and “none of the baseline pain lately.”  There were no positive findings on examination and ROM measurements were normal, but the examiner noted “some pain at terminal ranges” which was the basis for the VA’s 10% rating.

The panel’s main charge is to assess the fairness of the PEB’s determination that the left shoulder condition was not unfitting.  A level 2 profile does not mandate MEB referral and does not typically impose unfitting limitations.  Although the commander’s statement was a significant consideration, it was mitigated by the MEB opinion that the condition did not fail retention standards.  The case was confounded by the surgery near separation, but there was convincing evidence that by the time of separation the condition was even more favorable for retention.  Panel members ultimately agreed that, although the (non-dominant) shoulder condition may have contributed to some performance limitations, there was not a predominance of performance-based evidence from which to conclude that it in itself would have forced medical separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the left shoulder condition.  

Contended PEB Conditions: Back Pain and Bilateral Ulnar Neuropathies.  The CI experienced an onset of back pain with lifting in July 2008.  An MRI demonstrated disc protrusions (L3/4, L5/S1) without nerve impingement.  There was no associated radiculopathy or neurologic abnormalities and surgery was not indicated.  He experienced an atraumatic onset of intermittent bilateral hand paresthesias in January 2009 that were diagnosed by electrodiagnostic studies as ulnar neuropathies.  There were no motor symptoms or findings and no surgical indications.  The NARSUM did not document any significant severity or elaborate any specific functional limitations for either condition, and there were no positive findings on physical examination referable to either one.  Both conditions were opined to meet retention standards, neither was profiled and neither was implicated by the commander’s statement.

As above, the panel’s charge is to assess the fairness of the PEB’s determination that neither of these conditions was unfitting.  There was no performance-based evidence from the record that either of them significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determinations for the back or bilateral ulnar neuropathy conditions, so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the left and right ankle conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended left shoulder, back and bilateral ulnar neuropathy 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

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.

Sincerely,					      
Enclosure