RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01945
BRANCH OF SERVICE:  Army	BOARD DATE:  20150211
SEPARATION DATE:  20050709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Motor Transport Operator) medically separated for chronic right ankle pain and right small finger contracture and pain.  These conditions could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent U3L3 profile and referred for a Medical Evaluation Board (MEB).  The “right small finger contracture and pain (slight/intermittent) secondary to tendon reconstruction” and “right ankle pain, (slight/constant),” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic pain, right ankle, rated as slight/constant” and “right (dominant) small finger contracture and pain following tendon reconstruction as unfitting, rated 10% and 0% respectively, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “-Chronic Pain, Right Ankle as a result of Tendon Graft  -Right (Dominant) small Finger contracture and pain following tendon reconstruction.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

IPEB – Dated 20050518 | VA* - (~2 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Pain, Right Ankle | 5099-5003 | 10% | Residuals Of Right Ankle Tendon Graft | 5099-5024 | 10% | 20050901
Right (Dominant) Small Finger Contracture and Pain | 5230 | 0% | Residuals Of Injury Right Small Finger | 5227 | 0% | 20050901
Other x 0 (Not In Scope) | Scar, Right Ankle | 7802 | 0% | 20050901
| Other x 7
RATING:  10% | RATING:  20%
*Derived from VA Rating Decision (VARD) dated 20051205 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Chronic Pain, Right Ankle Condition.  Treatment records evidence that the CI initially reported right ankle pain after harvesting of the plantaris tendon from her right ankle in July 2004.  She underwent a post-operative course of physical therapy and anti-inflammatory medications without relief of the right ankle pain.  A treatment note prior to discharge from physical therapy documented right ankle pain especially at the end of the day.  The physical examination documented a mildly antalgic gait, mild tenderness to palpation at margins of the surgical scar, and full active right ankle range-of-motion (ROM).  The narrative summary (NARSUM) noted “right ankle pain secondary to plantaris tendon removal.”  The physical examination revealed mild right ankle swelling, hypersensitivity of the Achilles tendon, and pain limited ankle motion.  The gait was noted as normal.  The VA Compensation and Pension (C&P) examination dated 29 August 2005 documented that the CI worked at the Department of Motor Vehicles without any time lost from work and attended college.  The VA C&P examination dated 1 September 2005, 2 months after separation, documented tenderness to palpation at the right ankle surgical scar, a normal gait, and slightly decreased dorsiflexion and plantar flexion.  The goniometric 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.

Right Ankle ROM
(Degrees)

PT ~6 Mo. Pre-Sep

MEB ~5 Mo. Pre-Sep

VA C&P ~2 Mo. Post-Sep

Dorsiflexion (20 Normal) | 3 | 3 | 15
Plantar Flexion (45) | 30 | 30 | 40
Comment | Painful motion | Painful motion | Tenderness to palpation
§4.71a Rating | 10% | 10% | 10%

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic right ankle pain as unfitting, rated the condition at 10%, coded 5099-5003 (analogous to degenerative arthritis) and cited application of the USAPDA pain policy.  The VA rated the chronic right ankle condition at 10% and coded 5099-5024 (analogous to tenosynovitis).  The Board considered whether the evidence supported of a higher than 10% rating for the chronic right ankle pain condition.  There was no evidence of marked limitation of motion for a 20% rating under VASRD coded 5271 (ankle, limitation of motion or incapacitating exacerbation) for a 20% rating analogous to 5003.  The Board determined that PEB’s 10% rating analogous to 5003 (degenerative arthritis) was supported by the USAPDA pain policy and was compliant with VASRD §4.59 criteria for the painful motion.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the chronic right ankle pain condition was appropriately recommended in this case.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

Right (Dominant) Small Finger Contracture and Pain Condition.  Treatment records evidence that the CI sustained a right small finger injury after a fall in September 2003.  She was subsequently diagnosed with a right small finger tendon (flexor digitorum profundus) avulsion and underwent surgical repair on 23 January 2004.  She was treated post-operatively with occupational therapy and pain medications.  On 8 July 2004, the CI underwent a second surgery (Stage II) to repair the right small finger tendon avulsion with a tendon from her right foot (harvesting of the plantaris tendon).  The CI was treated post-operatively with occupational therapy (OT).  Despite surgical repair and OT, the CI continued to report intermittent pain in the forearm with coldness of the fingers.  An OT examination dated 28 January 2005 demonstrated significant loss of motion and strength in the right small finger.  The NARSUM examination revealed decreased ROM of the right small finger.  The VA C&P examination performed 2 months after separation, revealed a nontender right small finger surgical scar, fusion of the joint at the tip of the finger (proximal interphalangeal joint) to 0 degrees, and fusion of the joint at the middle of the finger (distal interphalangeal joint) to 15 degrees.  Radiographic evaluation demonstrated a “mild flexion deformity of the distal little finger.”  The examiner opined that the right small finger ROM impairment did not impact the CI’s activities of daily living or occupation.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB adjudicated the right (dominant) small finger contracture and pain condition as unfitting.  The PEB and VA rated the right small finger condition at zero percent.  The Board noted that the only VASRD rating for small finger ankylosis or limitation of motion was 0%.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 0% for the right (dominant) small finger contracture and pain condition was appropriately recommended in this case.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

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.  As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating chronic right ankle pain condition was operant in this case and the condition was adjudicated independently of that policy/instruction by the Board.  In the matter of the chronic right ankle pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  The Board did not surmise from the record or PEB ruling that any prerogatives outside the VASRD were exercised with regards to the right (dominant) small finger contracture and pain condition.  In the matter of the right (dominant) small finger contracture and pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131028, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX     
President 
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150010565 (PD201301945)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl			     XXXXXXXXXXXXXXX
				     Deputy Assistant Secretary of the Army
				          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01945