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AF | PDBR | CY2012 | PD2012 01110
Original file (PD2012 01110.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1201110
BRANCH OF SERVICE: Army  BOARD DATE: 20140507
SEPARATION DATE: 20021002


SUMMARY OF CASE: The available evidence indicates this covered individual (CI) was an active duty SSG/E-6 (11B/Infantryman) medically separated for chronic left ankle pain. This condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards. He was issued a permanent L3-H2 profile and referred for a Medical Evaluation Board (MEB). The ankle condition characterized as “left ankle: post traumatic arthritis,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded five other conditions (chronic hepatitis C, episodic low back pain, retropatellar pain syndrome, elevation of the systolic blood pressure and hearing loss), all of which met retention standards, for PEB adjudication. The PEB adjudicated “chronic left ankle pain…” as unfitting, rated 10%, with likely application of VA Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting . The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no contention in his application.


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 chronic left ankle pain 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 consideration by the Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20020912
 VA – (5 mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Ankle Pain 5010 10% Post Traumatic Arthritis Left Ankle 5010-5271 10%* 20030227
Other x 5 (Not in Scope)
 Other x 1 (Not in Scope) 20030227
Rated: 10%
 Rated: 10%
Derived from VA Rating Decision (VA RD ) dated 200 21220 .
*10% rating increased to 2 0% effective the day after separation by VARD dated 20030623 .


ANALYSIS SUMMARY:

Chronic Left Ankle Pain. The CI injured his left ankle while playing in a unit softball competition in March 1998. He was treated conservatively as the initial X-rays were essentially normal. In the following years, with several aggravating injuries, his left ankle pain continued and in late 2001 more advanced radiographic testing was performed. A bone scan revealed post-traumatic changes in the region of the left medial ankle consistent with degenerative joint disease. Five weeks later, a computer automated tomography (CAT) scan was performed and showed significant abnormal bone formation on the medial aspect of the ankle. In early 2002, he underwent surgical excision of that abnormal bone growth. After rehabilitation, the left ankle pain continued to limit his basic soldiering duties so he was referred for a MEB. The MEB physical exam (DD Form 2808) was accomplished almost 8 months prior to separation. The physical exam findings related to the left ankle were used in the narrative summary (NARSUM) and are summarized in the chart below. The NARSUM noted the chief compliant “when I first get up out of bed in the morning, I am okay for the first two to three steps and then my left foot starts aching and burning and it continues like this all day long. I get swelling in the foot and I have deep, aching pains that are in the bone. I can't run at all. I can't do push-ups. I can't do infantry stuff anymore." At the VA Compensation and Pension (C&P) exam , performed 5 months after separation, the CI reported a similar history to that outline d above with the additional comment “t he patient reports he is unable to run now well. He does try to jog with his wife, but cannot go very long without increasing the pain in the ankle. He has occasional swelling of the ankle.” The se physical exam findings are also summarized in the chart below.
invalid font number 31502
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:

Left Ankle ROM (Degrees)
 DD 2808 7 .5 Mo s . Pre-Sep VA C&P ~ 5 Mo s . Post-Sep
Dorsiflexion (20 Normal)
 10 5
Plantar Flexion (45)
 20 10
Comment
 Pos itive tenderness to palpation; No laxity or effusion; Norma l strength No swelling; Well healed surgical scar; Minimal tenderness to palpation

The Board directs attention to its rating recommendation based on the above evidence. The PEB used VASRD code 5010 (arthritis due to trauma) and rated it 10%. The VA initially used code 5010-5271 (limited motion of the ankle) and rated it 10%. Six months later, the VA increased the rating to 20% effective the day after separation. Code 5010 is rated as degenerative arthritis (code 5003) which allows for a 10% rating if the affected joint’s ROM is non-compensable; however, if the limitation of motion is compensable under the appropriate diagnostic codes for the specific joint or joints involved , then those joint specific codes will be used. In this case, the Board members agree d the limitation of motion in the CI’s left ankle was compensable under ankle code 5271 . The rating criteria for code 5271 are reflected below for the reader’s convenience:

5271 Ankle, limited motion of:
Marked ........................................... 20
Moderate ........................................ 10

The Board reviewed the evidence supporting a “moderate” or “marked” limitation of motion. The C&P exam, more consistent with a marked limitation of motion, was after separation but more proximate to separation than the MEB physical exam which was prior to separation and more consistent with a moderate limitation of motion. There was no interval history to account for the worsened ROM findings on the C&P exam. There was no documentation of the CI’s gait in the record which would have been helpful to establish higher probative value of one exam over the other. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% 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. 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 chronic left ankle pain condition, the Board unanimously recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


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

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Left Ankle Pain 5271 20%
RATED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120714, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX , AR20140018987 (PD201201110)
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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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