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AF | PDBR | CY2012 | PD2012 01105
Original file (PD2012 01105.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201105
BRANCH OF SERVICE: Army  BOARD DATE: 20130403
SEPARATION DATE: 20040316


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve S FC /E- 7 ( 91W / l icensed practical nurse ) medically separated for chronic right ankle pain . He had a h istory of multiple bilateral ankle sprains ( right more than left ) throughout his active duty. The condition 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 underwent a Medical Evaluation Board (MEB). The right ankle condition was found medically unacceptable IAW AR 40-501, and was forwarded to the Physical Evaluation Board (PEB). No other conditions were submitted by the MEB. The PEB found the chronic right ankle pain unfitting, and rated it 0 % . The CI made no appeals, and was medically separated with a 0% disability rating.


CI’s CONTENTION: “Right Ankle acquired Degenerative Joint Disease which interfered with my performance on the PT test.”


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 his application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the Army Board for Correction of Military Records.


RATING COMPARISON:

Army PEB – dated 20031125
 VA - (4 mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Ankle Pain
 5099-5003 0% Degenerative Joint Disease (DJD), Right Ankle 5271 20% 200 40728
No Additional MEB/PEB Entries
 Other x 6 20040728
Combined: 0%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 50228 ( most proximate to date of separation )


ANALYSIS SUMMARY:

Right Ankle. Over the course of several years, the CI suffered multiple ankle sprains, more on the right than on the left. Eventually, his right ankle problem became so bad, that he had difficulty walking without significant pain. Magnetic resonance imaging (MRI) in April 2003 showed loss of articular cartilage, with joint effusion and possible associated granulation tissue. Due to persistent right ankle pain, an MEB was initiated. His MEB clinical evaluation was in October 2003. Physical examination revealed mild swelling of the mid-foot and ankle, with mild tenderness to palpation (TTP) at the joint line. There was “near full” range-of-motion (ROM) of the right ankle. As noted above, the CI was medically separated from the Army in March 2004 due to chronic right ankle pain.

Four months later, he had a VA Compensation and Pension (C&P) exam. At that exam, the CI reported pain, instability, stiffness, and cramping in the right ankle. He was not using any medications on a regular basis, and he was not using any assistive devices. There were no additional effects on his usual occupation or daily activities, and no additional limitations following repetitive use. He was working in a maintenance position for the US Postal Service. Physical examination of the right ankle showed 20 degrees dorsiflexion, and 20 degrees plantar flexion. There was increased laxity on anterior drawer, both in neutral position and plantar flexion. X-rays of the right ankle showed moderately severe degenerative joint disease (DJD). The July 2004 goniometric ROM evaluation is summarized in the chart below.

Right Ankle ROM
 VA C&P ~ 4 m o. Post-Sep
 (200 40728 )
Dorsiflexion (20 ⁰ is n ormal)
 20 ⁰
Plantar Flexion (45 ⁰ is normal )
 20 ⁰
Comment
 Increased laxity
§4.71a Rating
 10%

The Board carefully reviewed all evidentiary information available. The Army PEB and VA chose different coding and rating options for the right ankle condition. The Board determined that IAW the Veterans Schedule for Rating Disabilities (VASRD) §4.71a, the diagnostic code that most closely aligns with limited ankle motion is 5271 (Ankle, limited motion of). Under code 5271, the rati ng levels are: 10% for moderate and 20% for marked. Following a thorough review of the record, the Board determined that the CI’s limitation of ankle motion was best described as “moderate.” T here was insufficient evidence in the treatment record to support classifying the right ankle condition as “ marked.” The Board tried to find a path to a rating higher than 1 0% , using other codes which could be applied to the right ankle condition. The other VASRD codes that were considered did not result in a rating higher than 10%, since the treatment record did not show evidence of a significantly disabling joint abnormality which would justify a rating higher than 10%. The CI was able to work, and engage in routine activities. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 ( resolution of reasonable doubt), the Board unanimously recommend s a separation disability rating of 10% for the right ankle condition. It is appropriately coded 5271, and IAW VASRD §4. 71a, meets criteria for the 10% rating level due to moderate limitation of motion .


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. In the matter of the chronic right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends a separation disability rating of 10%. There were no other conditions within the Board’s scope of review for consideration.



RECOMMENDATION: The Board, therefore, 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
Chronic r ight a nkle p ain , due to multiple ankle sprains
 5271 1 0%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120626, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20130009460 (PD201201105)
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 10% 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                                                 

                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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