Author: JOHN J. D'ORAZIO
Last saved by: BARKSDALE, JAMEILL M GS7 USAF SAF SAF/MRBE
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201833
BRANCH OF SERVICE:  Army	BOARD DATE:  20130409
SEPARATION DATE:  20020212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (52D/Power Generation Repair) medically separated for chronic left ankle pain.  The CI injured his left ankle sustaining a left tibial plafond fracture in 1998 when he fell off a truck.  He underwent reduction and percutaneous pinning of the fracture and in February 1999 had surgery to have the two screws removed.  The left ankle condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  His profile allowed for an alternate aerobic event to satisfy physical fitness requirements.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The left ankle condition, characterized as “left ankle pain status post fracture repair” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated left ankle pain as unfitting, rated 10%, citing criteria of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated with a 10% disability rating.

CI CONTENTION:  “ankle getting worse, wrist pain worse, grip strength lessened since discharged.  Have hearing loss do to weapon fire.” 

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left ankle condition is addressed below.  The requested “wrist pain and hearing loss” conditions were not identified by the MEB, and thus are not within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the respective Service Board for Correction of Military Records.  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:  
   
Service IPEB – Dated 20020109 | VA - (12 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Left Ankle Pain w/moderate limitation of motion | 5010-5271 | 10% | S/P Left Ankle Fx | 5299-5271 | 20% | 20030212
No Additional MEB/PEB Entries | Other x 2 | 20030212
Combined:  10% | Combined:  40%
Derived from VA Rating Decision (VARD) dated 20030407   

ANALYSIS SUMMARY: 

Left Ankle Pain Condition.  The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Ankle ROM
(Degrees)

MEB ~4.5 Mo. Pre-Sep
(20010928) p.337

VA C&P ~ 12 Mo. Post-Sep
(20030212) p.# 369

Dorsiflexion (20 Normal) | 5 | 15
Plantar Flexion (45) | 15 | 35
Comment | Painful motion noted | Pain w/resisted inversion/eversion
§4.71a Rating | 20% | 10%

The CI had a left ankle injury in November 1998, after falling off of a truck sustaining a fracture of the distal tibia at the ankle (plafond type due to vertical force mechanism of injury).  He underwent surgical repair of the fracture, recuperated well and had the hardware used in surgery removed a year later.  Despite undergoing therapy, medication management and being placed on several temporary and permanent profiles, the CI continued to complain of left ankle pain, as well as instability when performing strenuous physical activities like running.  The MEB narrative summary (NARSUM) physical exam performed on 28 September 2001, 5 months prior to separation, noted tenderness to palpation over the distal tibia and lateral malleolus.  There was no edema, no ecchymosis and the neuro-vascular exam was intact.  The ROM for the left ankle was dorsiflexion limited to less than 5 degrees, plantar flexion 15 degrees, inversion and eversion were five degrees each; motions accompanied by pain.  At the VA Compensation and Pension (C&P) exam performed on 12 February 2003, 12 months after separation, the CI had an antalgic gait but did not use any device to help him walking.  The CI was able to heel walk and raise the toe with minimal pain.  Dorsiflexion was 15 degrees, plantar flexion was 35 degrees, inversion and eversion were five degrees each.  The neuro-vascular exam was intact.  No pain or instability were noted.  There were two anterior and lateral postsurgical scars and they were both well healed.  X-ray exam of the left ankle revealed normal joint space with minimal osteoarthritic changes of the tibia, secondary to remote trauma.  

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA used the same code (5271) to rate the left ankle condition.  The PEB rated the left ankle pain condition 10% citing moderate limitation of motion.  The VA rated 20% for marked limitation of motion and ankle movement accompanied by pain based on the C&P examination.  The Board considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  The Board considered the limitation of motion at the time of the NARSUM to be more than moderately limited and more nearly approximated a marked degree of limitation.  Although the C&P examination a year after separation recorded improved ROM there remained pain with use and this examination was not proximate to the time of separation.  The Board also considered whether a higher rating was supported under other diagnostic code options.  There was no ankylosis to support a minimum rating under the respective code (5270).  The Board noted the underlying cause for the right foot impairment was residuals of a fracture of the tibia and considered rating using the VASRD diagnostic code 5262 (impairment of the tibia, fibula and ankle), however there was no malunion or nonunion to assign a rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the left ankle pain condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left ankle pain w/moderate limitation of motion condition, the Board unanimously recommends a disability rating of 20%, coded 5010-5271 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

UNFITTING CONDITION | VASRD CODE | RATING
Chronic Left Ankle Pain Following Tibial Plafond Fracture | 5010-5271 | 20%
RATING | 20%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20121005, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130009553 (PD201201833)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD1201833