RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00843
BRANCH OF SERVICE:  Army	BOARD DATE:  20141112
SEPARATION DATE:  20090727

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (92G/Food Service Specialist) medically separated for tenosynovitis of the left ankle condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The tenosynovitis condition, characterized as chronic left ankle pain and stiffness with degenerative joint disease (DJD) and tenosynovitis of the peroneal tendon, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also submitted five other conditions including a back condition.  The Informal PEB adjudicated tenosynovitis left ankle as unfitting, rated at 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated. 

CI CONTENTION:  “Scoliosis & Degenerative Joint disorder left ankle”.  

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 tenosynovitis left ankle and the not unfitting scoliosis conditions are addressed below; no other conditions are 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 Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20090603	IDES - (4 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tenosynovitis, Left Ankle	5271	10%	Tenosynovitis, Left Ankle	5271	10%	20090403	
Back Condition	Not Unfitting	DJD with Scoliosis	5003-5237	10%	20090403	
Other x 4  (Not in Scope)	Other x 4 	
Combined:  10%	Combined:  30%	
*Derived from VA Rating Decision (VARD) dated 20090810 (most proximate to date of separation)

ANALYSIS SUMMARY: 

Tenosynovitis, Left Ankle Condition. The records in evidence for the left ankle condition are relatively scant.  A request for a left ankle X-ray on 14 May 2008 noted that the CI sustained an inversion (twisting in) injury to the left ankle while running a month earlier.  Despite duty limitations and treatment (not specified), her pain had progressed.  The X-ray imaged revealed soft tissue swelling of the ankle and evidence of inflammation of the Achilles tendon at its insertion into the heel bone (calcaneus).  Subsequently, a magnetic resonance image (MRI) obtained on 22 July 2008 showed evidence of ligamentous damage consistent with the history of an inversion type sprain.  The CI’s pain persisted despite treatment therefore she was referred to the MEB process.  At the Integrated Disability Evaluation System (IDES) general medical examination performed 4 months prior to separation on 3 April 2009, the CI reported that she injured her ankle in February of 2008 when she tripped on the side of the road and landed on her ankle.  She reported constant pain, but was able to function without medications and denied giving way, lack of endurance, locking, fatigability, or dislocation.  As her symptoms worsen, it impacted her activities, to include walking.  On examination, she had an antalgic (guarding against pain) gait.  The ankle was stable, but soft tissue swelling and tenderness were present.  The range-of-motion (ROM) was reduced with dorsiflexion (toes up) of 12 degrees (20 normal) and plantar flexion (toes down) of 32 degrees (45 normal).  Both were limited an additional two degrees from pain on repetition.

The narrative summary (NARSUM) dated 1 May 2009 (approximately 3 months prior to separation), the CI reported chronic pain despite rehabilitation and that she had been told by orthopedics that she was not a surgical candidate.  On examination, the examiner noted that the gait was antalgic and slow; tenderness over the outside of the left ankle consistent with the prior injury.  The ROM cited was from the IDES examination.

The Board directed its attention to its rating recommendation based on the above evidence.  The CI was adjudicated as part of the pilot IDES project in which the PEB determined what was unfitting, but the VA recommended the rating and coding.  Accordingly, the PEB and VA both rated the ankle at 10% using the code 5271 (limited motion of the ankle), at a moderate level.  The Board considered the findings of an antalgic gait as well as limited and painful motion, but without instability or locking.  It found no route to a rating higher than the 10% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left ankle condition.  

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that back condition (contended as scoliosis) was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The back condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  The NARSUM recorded that the CI had reported an 8 month history of back pain to the VA and X-rays done as part of that examination showed thoracic (chest) scoliosis.  The CI reported on the MEB history that she had been sent to the emergency room by her supervisor for her back.  This record is not in evidence and there is no other record of evaluation or treatment of a back condition prior to this record (MEB history).  The back condition was reviewed by the Action Officer and considered by the Board.  There was no performance based evidence from the record that it significantly interfered with satisfactory duty performance.  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 contended back and so no additional disability rating is recommended.

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 condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended back conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX AR20150006625 (PD201400843)

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