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AF | PDBR | CY2012 | PD2012 00668
Original file (PD2012 00668.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD1200668
BRANCH OF SERVICE: Army  BOARD DATE: 20131126
SEPARATION DATE: 20021119


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-6 (95B30/Military Police) medically separated for a right ankle condition. He sustained the ankle injury in 2001 while playing volleyball during unit organization day. 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 right ankle condition, characterized as “right ankle pain, status post traumatic Achilles tendon rupture,” was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AR 40-501. No other conditions were submitted by the MEB. The IPEB adjudicated right ankle pain as unfitting rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI appealed to the Formal PEB (FPEB) which increased the IPEB rating to 20%. The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider this information and determine if whether I should have received a higher rating for medical condition(s) that resulted in separation, or whether I should have been found unfit and rated for other conditions that were considered in my PEB based on VASRD and other evidentiary standards. Deadline to respond IAW letter received dated: 18 June 2012 from the SAF/MRBR (PDBR Intake Unit) seems incorrect, since it showed the suspense date the same as the date of the letter received. I’ve included a courtesy copy of the same for your information.”


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 right ankle condition is addressed below; 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.


 RATING COMPARISON :

Service FPEB – Dated 20020807
 VA - (4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Ankle Pain 5099-5003 20% P/O residuals R/Achilles Tendon Rupture 5299-5284 20% 20020725
No Additional MEB/PEB Entries
 Other x 6 20020725
Combined: 20%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 20020725 ( most proximate to date of separation [ DOS ] ).



ANALYSIS SUMMARY:

Right Ankle Condition. The goniometric range-of-motion (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)
 MEB ~ 8 Mo. Pre-Sep
(20020306)
Ortho ~ 6 Mo. Pre-Sep
(20020507)
VA C&P ~ 4 Mo. Post-Sep
(20020725) (VARD)
Dorsiflexion (20 Normal)
 20 30 Reduced/pain
Plantar Flexion (45)
 50 45 Reduced/pain
Comment
 Unable to tiptoe ROM same as L ankle
Normal eversion and inversion.
 Pain with tiptoe
Unable to stand on tiptoe on right		 Pain with movement in all directions except plantar flexion
§4.71a Rating 5271
 0% * 0% * (VA assigned 20%)
*10% would be supported by painful motion (§4.59) or functional loss (§4.40) under code 5271

The CI ruptured his right Achilles tendon while playing unit volleyball in August 2001. He underwent repair of the tendon the same day at the local hospital that serviced the installation. Despite extensive rehabilitation from 29 August 2001 to 7 May 2002 (including physical therapy, ultrasound, transcutaneous electrical nerve stimulation, acupuncture, injections and oral pain medications), the CI failed to progress sufficiently to return to unrestricted duties. A physical therapy note on 27 February 2002 indicated that the CI’s right ankle achieved a functional ROM although not yet jumping or running with reduced strength (4/5). The MEB exam performed on 1 April 2002 described a normal ROM for the right ankle. His motor strength was assessed as 5/5 with pain on forced plantar flexion; however, he could not walk on tip-toes on the right foot due to pain but he could heel walk. During the MEB examination, the CI stated "I cannot walk normally without feeling any pain. The area still swells since the surgery was performed back 11 August 2001." The civilian orthopedic exam on 7 May 2002 recorded symmetric ankle ROM with ranges beyond the norms set by the VA Schedule for Rating Disabilities (VASRD). Inversion and eversion was recorded as normal. The civilian orthopedic evaluation described “marked symptoms of the right calcaneal tendon, especially a tender, painful swelling.” The orthopedist further described pain with walking on tiptoe. Plantar flexion could be carried out against resistance although pain did prevent standing on tiptoes on the right. The VA Compensation and Pension (C&P) exam performed on 25 July 2002, 4 months prior to separation, was not in the evidence available. However, the VARD dated 29 November 2002, cited this examination noting findings of swelling, tenderness and pain with use and motion. Motion was reported to be reduced in all planes due to pain, except for plantar flexion, without further detail.

The Board directs attention to its rating recommendation based on the above evidence. The FPEB rated the condition 20% with application of the USAPDA pain policy (coded 5099-5003) citing constant marked pain. The VA rated the condition 20% under diagnostic code 5284 (other foot injuries, moderately severe) based on the VA C&P examination. The ankle ROM examinations recorded by the MEB examination and the orthopedic surgeon demonstrated normal motion symmetric with the opposite ankle. Based on these examinations a minimum compensable rating under code 5271 (limitation of ankle motion) is not attained as the minimum rating is for moderate limitation of motion. The Board concluded that provisions of §4.59 (painful motion) and §4.40 (functional loss) would however support a 10% rating using this code. The disability was of the Achilles tendon rather than the ankle itself and the Board considered the approach by the VA using diagnostic code 5284, also reasonable in this case. The Board reviewed the VA C&P examination as described in the VARD noting it described more severe limitations than documented by the orthopedic examination approximately 2 months prior. The Board agreed the overall disability picture described in the STRs reflected a moderate impairment. All Board members agreed it did not approach a severe enough impairment to support a rating higher than that adjudicated by the PEB. The Board considered rating the condition in accordance with §4.56 (evaluation of muscle disabilities) utilizing code 5311 (Group XI) since the Achilles tendon is part of the muscle-tendon complex acting on the ankle, but could find no increase of benefit to the CI. The Board therefore agreed the condition is more appropriately coded 5299-5284; however, this administrative change provides no change in rating or benefit to the CI. 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 rating for the right 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 right ankle pain was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the right ankle pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB rating adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Right Ankle Pain
 5099-5003 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120625, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



        

XXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review


SFMR-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 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX, AR20140004562 (PD201200668)


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                                                  XXXXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

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