RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-05112
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050808

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Signals Intelligence Analyst, medically separated for “left foot and ankle pain” with a combined disability rating of 0%.

CI CONTENTION: “MED discharge of 0% versus VA rating of 80% service connected...rated for major depressive disorder/Bipolar II…left ankle subtalar coalition, disc degeneration cervical spine…”  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 FPEB - 20050615	VARD -	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Foot and Ankle Pain	5099-
5003	0%	
No VA Examination Proximate to Separation in Evidence	
Adjustment Disorder with Mixed Disturbance of Conduct and Emotions	Not Unfitting		
Mixed Personality Disorder with Histrionic Traits	Not Unfitting		
Recurrent Neck Pain	Not Unfitting		
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS:	

ANALYSIS SUMMARY:

Left Foot and Ankle Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left foot and ankle condition began in March 2004 with running and

long distance walking but no reported trauma or injury. Custom orthotics provided only temporary relief. Weight bearing X-rays of both feet in September 2004 showed evidence of a previous bunionectomy on the left with good restoration of normal anatomy and a hallux valgus of a moderate degree with a bunion on the right. Repeat left foot lateral view X-rays in October 2004 showed decreased definition and space of the anterior subtalar facet and increased subchondral sclerosis in the calcaneus, but beneath the anterior and posterior facets. A CT scan in November 2004 demonstrated a left calcaneal, subtalar coalition and the right ankle was unremarkable.

At a 15 December 2004 MEB consultation examination the CI’s ankle range of motion (ROM) measurements were dorsiflexion 15 degrees (normal 20) and plantar flexion 90 degrees (normal 45). There was a decrease in the ROM of the first metatarsophalangeal joint of the left foot. Since conservative treatment with custom, semi-rigid orthoses, nonsteroidal anti-inflammatory medications, and wraps were not successful in treating her pain, surgical intervention consisting of a subtalar fusion was discussed; however, because of the prolonged healing process and high failure rate of that type of surgery, the CI chose not to take the risk.

The 29 March 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant left ankle pain which was aggravated by prolonged standing, walking on uneven terrain, going up hills, or anything of high impact. Physical examination showed left ankle dorsiflexion of 0 degrees, plantar flexion was 0-60 degrees. The examiner’s diagnoses were left ankle pain and foot pain secondary to subtalar coalition and status post bunionectomy of the left foot. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left foot and ankle condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the condition was rated for moderate/intermittent pain. Panel members agreed that the ROM examinations proximate to separation were consistent with the “moderate” limitation of motion required for the 10% rating under this code since dorsiflexion was 0 degrees and plantar flexion was 60 degrees at the NARSUM examination. Use of alternate ankle or foot codes offer no higher rating options. 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 foot and ankle condition, coded 5271.

Contended PEB Conditions: Adjustment Disorder with Mixed Disturbance of Conduct and Emotions, Mixed Personality Disorder with Histrionic Traits, and Recurrent Neck Pain. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The contended neck pain was not profiled or implicated in the commander’s statement, and did not fail retention standards. Neither an adjustment disorder nor a personality disorder are conditions that constitute a physical disability and are therefore not compensable. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determinations for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the left foot and ankle condition, the panel recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a. In the matter of the contended adjustment disorder with mixed disturbance of conduct and emotions, mixed personality disorder with histrionic traits conditions, and recurrent neck pain, 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 Foot and Ankle Pain	5271	10%	

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Dear XXXXXXXXXXXXX:

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 been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXXXXXXXXX
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