RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200865 SEPARATION DATE: 20030724 

BOARD DATE: 20130315 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SGT/E-5 (91W/Medic) medically separated for a 
bilateral ankle condition. He began experiencing ankle problems in 1996; and, over the ensuing 
years presented with intermittent strains, pain and ankle instability. He underwent surgical 
intervention for the left ankle in 2001, and for the right in 2002. The conditions could not be 
adequately rehabilitated to meet the physical requirements of his Military Occupational 
Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and 
referred for a Medical Evaluation Board (MEB). The condition, characterized as “bilateral 
ankles: persistent pain,” was forwarded to the Physical Evaluation Board (PEB) as medically 
unacceptable IAW AR 40-507. The MEB also identified and forwarded seven other conditions 
(see rating chart below) judged to meet retention standards. The PEB adjudicated “bilateral 
ankle pain” as unfitting, rated 0%, citing criteria of the US Army Physical Disability Agency 
(USAPDA) pain policy. The remaining conditions were determined to be not unfitting. The CI 
made no appeals, and was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “It has been almost 10 yrs and to this date I suffer from my pains every day. 
My ankles limit my ability on how much I can lift without the sharp shooting pains. As well how 
long I can stand or walk. I suffer from constant back pains on a daily bases and now my 
hypertension is starting to affect my daily living, that of anger and pain because of it, it has 
been a big part of 2 heart attacks in the past 6 months.” 

 

 

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 ankle condition is 
addressed below. The requested lumbar and depressive disorder (by implication) conditions, 
which were determined to be not unfitting by the PEB, are likewise addressed below. The 
hypertension and cardiac conditions mentioned in the application were not identified by the 
PEB, and thus are not within the DoDI 6040.44 defined purview of the Board. Those, and any 
other conditions or contention not requested in this application, remain eligible for future 
consideration by the respective 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 Veterans 
Affairs, operating under a different set of laws. Post-separation evidence is probative to the 
Board’s recommendations only to the extent that it reasonably reflects the disability at the time 
of separation. The Board likewise acknowledges the CI’s contention for rating of his lumbar and 
depressive disorder conditions which were determined to be not unfitting by the PEB; and, 


emphasizes that disability compensation may only be offered for those conditions that cut 
short the member’s career. Should the Board judge that any contested condition was most 
likely incompatible with the specific duty requirements; a disability rating IAW the Veterans 
Affairs Schedule for Rating Disabilities (VASRD), and based on the degree of disability evidenced 
at separation, will be recommended. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20030404 

VA (7 weeks Pre-Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bilateral Ankle Pain… 

5099-5003 

0% 

Surgical Residuals, Left Ankle 

5271 

10% 

20030602 

Surgical Residuals, Right Ankle 

5271 

10% 

20030602 

Plantar Fasciitis 

Not Unfitting 

Plantar Fasciitis, Right Foot 

5284 

0% 

20030602 

Plantar Fasciitis, Left Foot 

5284 

0% 

20030602 

Major Depressive Disorder 

Not Unfitting 

Major Depressive Disorder 

9434 

30% 

20030530 

Personality Disorder 

Not Unfitting 

Personality Disorder 

9499-9440 

NSC 

20030530 

Episodic Low Back Pain 

Not Unfitting 

Lumbar Degenerative Disc 

5293-5292 

20% 

20030602 

Occasional Migraine 

Not Unfitting 

Tension Headaches 

8100 

NSC 

20030602 

GERD 

Not Unfitting 

GERD 

7399-7346 

0% 

20030602 

Fatty Liver 

Not Unfitting 

Liver Fatty Infiltration 

7312 

NSC 

20030602 

No Additional MEB/PEB Entries 

Other X 3 (Included Hypertension Rated 10%) 

20030602 

Combined: 0% 

Combined: 70% 



Derived from VA Rating Decision (VARD) dated 20030903 (most proximate to date of separation [DOS]). 

 

 

ANALYSIS SUMMARY: 

 

Bilateral Ankle Condition(s). The CI first presented with ankle pain after a run in 1996. There 
are various entries in the service treatment record (STR) after that for similar complaints. He 
came to orthopedic attention in January 2000, and was noted with bilateral instability. He was 
treated with physical therapy and conservative measures without success. He underwent 
separate arthroscopic Broström procedures in 2001 and 2002. Radiographic evaluation 
revealed no evidence of arthritis or malalignment. The surgeries improved the mechanical 
instability, but the pain persisted and MEB referral ensued. The narrative summary (NARSUM) 
noted the CI’s preference to wear ankle braces for “perceived” instability; and, noted 
aggravation with negotiating uneven terrain, prolonged standing, running, and heavy lifting. 
The physical examination noted tenderness with no other positive findings. The range-of-
motion (ROM) measurements were 10 degrees dorsiflexion (20 degrees normal) bilaterally 
(with pain); and 40 degrees left/35 degrees right plantar flexion (45 degrees normal). MEB 
outpatient notes documented grossly normal ROMs. At the VA Compensation and Pension 
(C&P) evaluation (7 weeks prior to separation), the CI reported daily bilateral ankle pain worse 
with running, jogging, and prolonged standing or sitting. He continued to wear a brace, 
although joints were stable by exam. No tenderness or other positive joint findings were 
documented. The VA ROM evaluation documented bilateral painful motion, with dorsiflexion 
of 10 degrees bilaterally and plantar flexion of 40 degrees bilaterally. 

 

The Board directs attention to its rating recommendations based on the above evidence. IAW 
VASRD §4.7 (higher of two evaluations), the Board must consider separate ratings for PEB 
bilateral joint adjudications; although, separate fitness assessments must justify each disability 
rating. In this case, both ankles were considered to fail retention standards; both were 


implicated by the NARSUM and the commander’s statement; and, both were profiled. 
Members agreed therefore that each joint should be conceded as separately unfitting; and, 
that coding and rating features were logically identical. The PEB’s 0% bilateral rating, analogous 
to code 5003 (degenerative arthritis), rested on application of the USAPDA pain policy which 
circumvents VASRD §4.59 (painful motion); and, both the MEB and VA examiners documented 
pain-limited motion. There was no ankylosis, malunion or mechanical instability of either ankle 
which would justify application of any available joint code other than 5271 (ankle limitation of 
motion); the latter offering ratings of 10% for ‘moderate’ and 20% for ‘marked’ limitation. The 
modest ROM restrictions in evidence would not justify more than the 10% rating under this 
code, with or without application of §4.59. After due deliberation, considering all of the 
evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends that the 
bilateral ankle condition be rated as separately unfitting joints; each coded 5271 and rated 
10%. 

 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
were a lumbar spine condition and major depressive disorder (MDD). The CI had a history of 
back pain dating to 1997 without profiles; and, there were no STR entries for active treatment 
in the years preceding separation. The psychiatric addendum to the NARSUM noted a self-
referral to Mental Health in August 2002. The MEB psychiatrist specifically stated, “He does not 
need a psychiatric profile. He does not meet the requirement for a medical board based on his 
diagnosis of major depressive disorder.” 

 

The Board’s first charge with respect to these conditions is an assessment of the 
appropriateness of the PEB’s fitness adjudications. 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. 
None of these conditions were profiled; none were implicated in the commander’s statement; 
and, none were judged to fail retention standards. All were reviewed by the action officer and 
considered by the Board. There was no indication from the record that any of these conditions 
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 either the 
lumbar spine or MDD conditions. 

 

 

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 ankle condition was operant in this case and 
the condition was adjudicated independently of that policy by the Board. In the matter of the 
bilateral ankle pain condition, the Board unanimously recommends that it be rated for two 
separate unfitting conditions as follows: 10% for the right ankle and 10% for the left ankle, each 
coded 5271, IAW VASRD §4.71a. In the matter of the contended lumbar condition and major 
depressive disorder, the Board unanimously recommends no change from the PEB 
determinations as not unfitting. There were no other conditions within the Board’s scope of 
review for consideration. 

 

 

RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation: 


 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Surgical Residuals, Right Ankle 

5271 

10% 

Surgical Residuals, Left Ankle 

5271 

10% 

COMBINED (w/ BLF) 

20% 



 

 


The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120610, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxxxx, AR20130007712 (PD201200865) 

 

 

1. 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 to modify the individual’s disability rating to 20% without recharacterization 
of the individual’s separation. This decision is final. 

 

2. I direct that all the Department of the Army records of the individual concerned be corrected 
accordingly no later than 120 days from the date of this memorandum. 

 

3. I request that a copy of the corrections and any related correspondence be provided to the 
individual concerned, counsel (if any), any Members of Congress who have shown interest, and 
to the Army Review Boards Agency with a copy of this memorandum without enclosures. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)