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AF | PDBR | CY2012 | PD 2012 01642
Original file (PD 2012 01642.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2012-01642
BRANCH OF SERVICE: Army         BOARD DATE: 20140923
SEPARATION DATE: 20030522


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (92G10/Food Service Specialist) medically separated for a left ankle condition. The left ankle 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 left ankle condition, characterized by the MEB as “chronic ankle pain secondary to bone effusion effect” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic ankle pain secondary to bone effusion effect” as unfitting, rated at 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals and was medically separated.


CI CONTENTION: “The reason for requested change is that when I was first injured they classified my injury as a break in my left ankle. The VA classified it as a sprain. I have had constant pain and swelling in this ankle for the last 8 years, I have made the VA aware of this numerous times a year over this timeframe. They diagnosed me with gout and said my pain was from that. I consulted other was told to change general practisioners. Once I did this he agreed that this pain was not cause soley by the gout and sent me to have an MRI, xray done and to a specialist. The xray found degenerative arthitise and the MRI found that I still had a torn tendon with scar tissue that was not found or treated while I was on active duty. Since the brace was placed on my foot it has cause other issues in my knees, hips and lower back. This has been reported to my PCP. Podiatry tried to level me out with a shoe insert but that has failed to relieve pain.”


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 and no additional 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.

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 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 Veteran Affairs, operating under a different set of laws.




 RATING COMPARISON :

Service IPEB – Dated 20030321
 VA – STR Used
Condition
 Code Rating Condition Code Rating Exam
Chronic Ankle Pain Secondary to Bone Effusion Effect 5099-5003 10% Sprain, Left Ankle 5299-5271 10% STR
Other x 0 (Not in Scope)
 Other x 5 STR
Rating: 10%
 Rating: 10%
* Derived from VA Rating Decision (VA RD ) dated 200 30711 (most proximate to date of separation )


ANALYSIS SUMMARY:

Left Ankle Condition. The narrative summary (NARSUM) notes the CI had a history of multiple sprains of the ankle and experienced an avulsion fracture (ligament sprain/tear that takes a small piece of bone with it) of his left ankle 6 months earlier. The orthopedic evaluation performed on 25 September 2002 noted a small avulsion fracture of the inner ankle (medial malleolus) on X-ray images. The ankle was casted; however the CI continued to have pain despite medications and physical therapy. Repeated X-rays of the left ankle obtained on 6 December 2002 noted an area of calcification over the lateral aspect of the ankle (talofibular ligament), possibly due to a fracture fragment, but a magnetic resonance imaging (MRI) obtained on 31 December 2002 showed a joint effusion without bone or ligament abnormalities.

At the MEB examination performed on 5 February 2003, the CI reported ankle pain. The MEB physical exam noted a slow, antalgic gait. Ankle range-of-motion (ROM) was dorsiflexion 10 degrees (normal 20 degrees) and plantar flexion of 40 degrees (normal 45 degrees), with painful eversion/inversion motions. There was no discoloration or swelling noted and strength, sensation and reflexes were normal throughout the examination. The exam noted that the CI was using a controlled ankle motion (CAM) walker and crutches.

The original VA Rating Decision (VARD) was based upon service medical records. VA Outpatient treatment notes from March 2004 to January 2005 indicated that the CI continued with left ankle pain and swelling. Ankle plain films and MRI at the VA were noted to be read as normal. A bone scan was reviewed by a podiatrist and thought to represent degenerative ankle arthritis. An orthopedic evaluation obtained on 27 August 2004 noted full ankle ROM without instability with no indication for surgery and recommended shoe inserts. The CI was treated for gout without improvement and notes indicated that further evaluation was pending.

The VARD dated 14 January 2005 cited a VA Compensation and Pension (C&P) examination performed on 23 December 2004 which noted full ankle ROM, with pain and a limp. A remote VA C&P evaluation in February 2012 noted a continued diagnosis of ankle degenerative joint disease.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the chronic left ankle pain at 10%, coded 5099-5003 and cited the USAPDA pain policy. The VA also rated the ankle condition at 10%, coded 5299-5271 (analogous to limited ankle motion). Later VARDs in medical records to April 2012 continued the 10% rating for the ankle. At the MEB examination the CI had limited, painful ROM of the ankle, without swelling, but was still using a CAM walker and crutches. However, evaluations at the VA which began within the 12 month post-separation period defined by DoDI 6040.44 for special consideration of VA evidence supported that the ankle was painful but had full ROM, without instability noted on orthopedic examination. The Board agreed that this met a 10% rating utilizing either VASRD code 5003 or 5271 IAW §4.59 (Painful motion) and no higher evaluation was achieved with any applicable code IAW §4.71a. There was no evidence in record of any other ratable impairment of the left ankle. 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 chronic 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. As discussed above, PEB reliance on the USAPDA pain policy for rating the left ankle condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic ankle 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 20120822, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX , AR20150003252 (PD201201642)

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

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