RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01152
BRANCH OF SERVICE:  Army	BOARD DATE:  20141212
SEPARATION DATE:  20081024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Laundry and Bath Specialist) medically separated for right ankle arthritis.  The ankle condition did not improve adequately to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and underwent a Medical Evaluation Board (MEB).  The right ankle condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also forwarded congenital club foot, noting that it existed prior to service (EPTS).  The Informal PEB found the right ankle condition unfitting, and rated it 20%, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  The PEB determined that the right ankle condition was EPTS, but permanently service-aggravated.  The CI made no appeals at that time and was medically separated.

CI CONTENTION:  “I believe I should have received a higher rating because my disability limits me greatly. The only job I can hold is truck driving. I can’t advance my career ever.”  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 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:

Service IPEB – dated 20081009	VA – (12 mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Triple Joint Arthritis	5003-5271	20%	Right Ankle Arthrodesis w/DJD	5010-5270	20%	20091103	
Other x 0 (Not in Scope)	Other x 3	
Combined:  20%	Combined:  50%	
Derived from VA Rating Decision (VARD) dated 20091208 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Right Ankle Condition.  As a child, this CI had clubfoot of his right lower extremity.  He underwent multiple surgeries to correct the congenital defect.  In July 2003, when he entered the Army at age 18, he was doing well.  He was able to do all of the strenuous activities of going through Boot Camp.  In 2007 he was in Iraq and started having significant pain.  He was medically evacuated from Iraq to CONUS.  On X-ray, he was found to have degenerative changes in the right ankle.  In February 2008, he had a triple arthrodesis (fusion) of the right ankle.  After surgery, his ankle pain persisted and MEB was initiated.

The MEB narrative summary was dictated on 17 June 2008.  At the MEB exam, the CI reported that he was able to walk without difficulty, but not able to run.  On physical examination (PE) of the right ankle, there was no sign of infection.  Range-of-motion (ROM) was about 20 to 30 degrees.  Neurological exam was normal.  The examiner’s diagnoses were triple joint arthritis, and congenital clubfoot.  In July 2008, ankle ROM was measured by physical therapy (PT).  Those measurements are shown in the chart below.

At the VA Compensation and Pension exam on 3 November 2009 (12 months after separation), he reported that he could not run.  He was able to walk about 2 blocks, and then pain limited further walking.  His right ankle was worse with cold, and better with warmth.  His gait was mildly antalgic.  On PE of the right ankle, there was tenderness to palpation.  No ligamentous laxity was noted.  There was atrophy of the right calf muscle, which the CI reported had been present since childhood.  ROM testing showed 4-14 degrees of plantar flexion (10 degrees of total motion).  There was no observed manifestation of pain with ankle motion.  Neurologic exam was normal.  The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Right Ankle ROM
(Degrees)	PT~ 3 mos. Pre-Sep
(20080724)	VA C&P ~ 12 mos. Post-Sep
(20091103)	
Dorsiflexion (20 Normal)	0	none	
Plantar Flexion (45)	15	4-14	
§4.71a Rating	20%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA chose different coding options for the right ankle condition, but both assigned a 20% disability rating.  The PEB chose code 5271 (ankle limited motion of: marked) and the VA chose code 5270 (Ankle, ankylosis of: In plantar flexion, less than 30 degrees).  After reviewing the evidence, all Board members agreed that at the time of separation, the CI had marked limitation of right ankle motion.  IAW VASRD §4.71a, diagnostic code 5271, a 20% rating is warranted for marked limitation of ankle motion.  The Board tried to find a path to a higher rating, using other codes which could be applied to the ankle condition.  No other VASRD codes that were considered resulted in a higher rating, since the record did not show sufficient evidence of an ankle condition which would justify a higher rating.  After due deliberation, the Board determined that a disability rating of 20% was appropriate for the right ankle condition.  Considering all 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 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 20140228, 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 XXXXXXXXXXXXXXX, AR20150009582 (PD201401152)

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