RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-02413
BRANCH OF SERVICE:  Army 	BOARD DATE:  20150403
SEPARATION DATE:  20071218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (CH-47 Helicopter Repairer) medically separated for a right ankle condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “stress fractures lateral and medial malleoli or the right ankle; osteochondral defect lesion to the right ankle” and “chronic right ankle pain” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right ankle decreased range of motion [ROM] and chronic pain” as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI contends additional conditions beyond the right ankle condition.  His complete submission is at Exhibit A.

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 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 20070927 | VA* - (~1 Mos. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Right Ankle Decrease ROM and Chronic Pain | 5271 | 10% | S/P Surgery, R Ankle with Deg Changes and Post-op Residuals | 5271 | 20% | 20071119
Other MEB/PEB Conditions x 0 (Not In Scope) | Other x 5
RATING:  10% | RATING:  20%
*Derived from VA Rating Decision (VARD) dated 20080111 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Stress Fractures and Right Ankle Pain.  The CI sprained his right ankle in June 2006 and was managed conservatively with medications, physical therapy (PT), and activity restriction.  On 11 November 2006, he reinjured his right ankle as well as the left ankle in a motor vehicle accident.  He had increased pain and swelling which did not respond adequately to PT.  Per the narrative summary (NARSUM), X-rays and magnetic resonance imaging in late April 2007 showed degenerative joint changes and a torn ligament in the right ankle.   In a podiatry evaluation on 9 July 2007, he was noted to have painful motion of the right ankle and dorsiflexion (toes up) was reduced by 10 degrees.  No comment was made on plantar flexion (toes down).  Swelling and tenderness were present, but the ankle was stable.  The neurological examination was normal.  At the MEB examination on 20 July 2007, the CI reported pain, numbness, and tingling in the right foot.  The examiner noted decreased light touch to the sole near the heel and decreased dorsiflexion.  The NARSUM was dated 15 August 2007, less than 4 months prior to separation and 2 months after a second surgery.  It noted that the CI had undergone surgery for his right ankle (these records were not in evidence, but this did not affect the adjudication of the case).  He appeared to have procedures on 7 July 2006 and 14 June 2007.  He reported continued numbness of the right foot as outlined above.  On examination, he walked with a slight limp and had a healed scar on the inside aspect of the right ankle.  Light touch was decreased near the heel and dorsiflexion reduced secondary to a mechanical block.  

At the VA Compensation and Pension (C&P) examination was performed on 19 November 2007, a month prior to separation.  He could dress himself and drive a car, but do nothing else “…in current condition.”  The CI reported giving way, locking, lack of endurance, fatigability, and dislocation when he walks with constant pain.  For recreation, he reported bowling, broom ball (a ball game on ice), and running.  On the review of systems, he reported that he could sustain heavy physical activities without immediate distress.  The Board could not reconcile the inconsistencies in the history.  On examination, he used no assistive devices and had a normal gait.  There was an area of abnormal sensation about the heel.  The neurological examination was normal as were X-rays.  A post-separation orthopedic evaluation performed on 7 November 2008 showed normal strength in the ankle in all planes of motion without instability.  Slight swelling was present compared to the left ankle.  He was issued ankle braces.  The ROM was not recorded.  X-rays showed old changes consistent with the previous fractures, but the joint space was intact.  Otherwise the examination was normal.  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)

Podiatry ~5 Mo. Pre-Sep

MEB/PT ~4 Mo. Pre-Sep

VA C&P ~1 Mo. Pre-Sep

Dorsiflexion (20 Normal) | 10 | 0/0/0 | 10
Plantar Flexion (45) | --- | 35/35/35 | 15
Comment | Painful motion; nml neuro | Limp; Two Mo. post-op | Nml gait
§4.71a Rating | -- | 20% | 10%

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both used the code 5271 (limitation of motion), but rated the ankle at 10% and 20%, respectively, for moderate and severe loss of motion, again respectively.  The Board determined that the VA C&P examination had the higher probative value as it was 3 months further from the second surgery and closer to separation.  On this examination, the CI had reduced ROM, but a normal gait.  The neurological examination was normal implying reasonable function as well as weakness was not present.  The presence of a normal gait is not consistent with a marked limitation in motion and the evidence supports a moderate disability.  The scar was also considered.  There is no indication in the record that the CI was restricted from military foot wear other than in the post-operative recovery period.  The evidence does not support that this was unfitting at separation.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the right ankle 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 right ankle 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 20131119, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX 
President 
DoD 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 XXXXXXXXXXXXXXXXXXXX, AR20150015859 (PD201302413)

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

PD-2013-02413