RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05851
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Fire Control Systems Repairer, medically separated for “chronic right ankle pain, status post [s/p] open reduction internal fixation [ORIF], without neurologic abnormality” and “left heel plantar fasciitis,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  Both injuries are causing constant pain, and much discomfort daily.  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 - 20050819	VARD - 20060302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain, S/P ORIF, without Neurologic Abnormality	5099-5003	10%	Trimalleolar Fracture Dislocation S/P ORIF with Retained Ortho-pedic Appliances, Right Ankle	5262	10%	20060119	
Left Heel Plantar Fasciitis	5399-5310	0%	Calcaneal Spur, Left Foot	5284-5015	0%	20060119	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI fractured her right ankle while playing basketball in September 2003, and underwent an ORIF the same day.  On 1 March 2005, X-rays demonstrated postoperative changes and a small spur at the calcaneus.  

During the 12 April 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, physical examination revealed ankle tenderness and full range of motion.  The 5 July 2005 MEB NARSUM examination, 2 months before separation, documented complaints of right ankle pain, and the examiner noted well-healed incisions with decreased sensation, slight swelling, and tenderness from the ankle to mid shin.  Goniometrically measured ROM recorded dorsiflexion to 10 degrees (normal 20) and plantar flexion to 45 degrees (normal).  There was 5/5 and 4+/5 motor strength of the muscles supporting the ankle and knee.  

At the 19 January 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported developing right knee discomfort due to the ankle injury.  She was scheduled for a partial hardware removal the following week due to minor irritation from two screws and medial tenderness of the ankle.  Physical examination showed normal gait and stance, with no ankle deformity, swelling or instability.  Dorsiflexion was to 20 degrees and plantar flexion to 50 degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing slight and constant pain in accordance with the US Army Physical Disability Agency pain policy.  The VA also rated the right ankle condition 10%, but coded 5262 (tibia and fibula, impairment of), based on the C&P examination, citing malunion of the tibia and fibula, with slight knee or ankle disability.  Panel members agreed that a 10% rating, but no higher, was justified for painful right ankle motion and functional loss, IAW §§§4.59, 4.45, and 4.40.  The panel considered the decreased dorsiflexion during the NARSUM examination, but adjudged that the ROM was not severe enough to warrant a 20% rating for limitation of motion under code 5271.  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 ankle condition.  

Left Heel Plantar Fasciitis.  According to the STR and MEB NARSUM, the CI’s left heel condition began insidiously in September 2004 after ruck marching and prolonged activity.  Left foot X-rays in February 2005 revealed a small spur of the left calcaneus with no evidence of additional bony changes.  The MEB NARSUM examination noted complaints of left plantar heel pain that improved with heel cups.  Physical examination showed tenderness over the plantar fascia of the heel, and full motor strength in all muscle groups tested.

At the C&P examination, the CI reported occasional left heel pain which did not bother her at the time.  Physical examination showed normal gait and stance, but no other objective findings were noted during the examination.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left heel condition 0%, analogously coded 5399-5310 (movement of forefoot and toes), citing slight pain.  The VA also rated the left heel condition 0%, but analogously coded 5284-5015 (foot injuries, other-bones, new growths), based on the C&P examination, citing no objective evidence of painful or limited motion of a major joint or group of minor joints.  Panel members agreed that a 0% rating, but no higher, was justified for the left heel condition based on full muscle strength and normal gait and stance.  The single finding of tenderness over the plantar fascia of the heel was adjudged to not rise to the level of moderate impairment under code 5310.  The CI reported improvement with treatment, and during the C&P examination, occasional pain without significant impairment was documented with no objective findings of painful motion or limitation of motion.  There were no additional applicable VASRD codes that would result in a compensable 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 heel plantar fasciitis condition.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the left heel plantar fasciitis and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXX:

	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