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AF | PDBR | CY2012 | PD2012 01162
Original file (PD2012 01162.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201162
BRANCH OF SERVICE: Army  BOARD DATE: 20130306
SEPARATION DATE: 20030131


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (68G/Airframe Structure Repair Specialist), medically separated for chronic right foot and ankle sprain. During a live fire exercise CI fell into a foxhole, twisting his right ankle and sustaining injury to his right foot. Radiographs revealed a right talar fracture. He went through an open reduction and internal fixation (ORIF). He was able to ambulate without much pain, but had not returned to full active duty. The CI 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 MEB forwarded no other conditions for Informal Physical Evaluation Board (IPEB) adjudication. The IPEB adjudicated chronic right foot and ankle pain conditions as unfitting rated 10%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI appealed to the Formal PEB (FPEB), which affirmed the IPEB findings.


CI CONTENTION: “I. Degenerative Disc Disease lower back. 2. Residuals, right ankle fracture with degenerative joint disease 3. Left foot plantar fasciitis with calcaneal spur associated with residuals, right ankle fracture with claimed degenerative joint disease. 4. Tinnitus 5. Allergic Rhinitis”.


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The conditions chronic right foot and ankle pain as requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; and, are addressed below, in addition to a review of the ratings for the unfitting conditions. The other requested conditions degenerative disc disease (DDD), lower back, left foot plantar fasciitis with calcaneal spur, tinnitus and allergic rhinitis are not within the Board’s purview. 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 Army Board for Correction of Military Records.


 RATING COMPARISON :

Service FPEB – Dated 20021126
 VA - (1 Mos. Pre -Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Foot and Ankle Pain 5099-5003 10% Right Ankle Fracture (also claimed as right foot pain) 5271 10% 20021223
No Additional MEB/PEB Entries
 Other x 4 20021223
Combined: 10%
 Combined: 20%



ANALYSIS SUMMARY:

Chronic Right Foot and Ankle Pain Condition. The medical records indicate a history of chronic ankle and foot pain. The CI had X-rays and CT scans that revealed a talar fracture. He underwent ORIF surgery. Postoperatively he had pain and ankle popping. A year post surgery follow up orthopedic visit revealed a normal exam. Tests of ankle/foot instability were negative, no pain noted with dorsiflexion, strength was 5/5 and the doctor assessed “ankle pain of unclear source.” Radiographs indicated hardware was in place and no evidence of acute fracture or dislocation. On 2 April 2002, hardware was removed, yet pain continued. In August 2002, 5 months prior to separation, orthopedic examination reported range-of-motion (ROM) dorsiflexion 20 degrees, plantar flexion of 35 and intact sensation, with tenderness to palpation. Radiographs, CT scan, and magnetic resonance imaging (MRI) reportedly demonstrated normal joint space with no significant evidence of osteoarthritis, avascular necrosis (AVN), or any other talar lesion. Additional surgery was not indicated. At the MEB/narrative summary (NARSUM) examination, 2 October 2002, approximately 3 months prior to separation, the CI reported persistent ankle pain after surgery. He was able to ambulate without much pain but while in Korea his pain was exacerbated with running, and carrying the rucksack. Physical examination revealed dorsiflexion of 20 degrees, plantar flexion to 35, and full inversion and eversion. There was tenderness to palpation, tests of instability were negative; he was able to heel to toe walk, and no muscle weakness present. Neurological exam was normal with the exception of slight decrease sensation over the surgical area of the foot, noted to have been present since surgery.

At the Compensation and Pension (C&P) evaluation on 23 December 2002, approximately a month prior to separation, the CI reported daily pain that worsens with weight bearing and with walking greater than a mile. VA examiner noted a mild limp favoring the right lower extremity. Right ankle flexion noted 45 degrees with extension of 20; and normal sensation except decrease over the area of the surgical scar. There was tenderness to palpation in an area below the scar. There was no instability and ROM was not limited by repetitive movement. The examiner opined, “No evidence of right foot problems.” The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA chose different coding options for the condition. The PEB rated the condition under the analogous 5299- 5003 code (degenerative arthritis) and assigned a 10% rating with the application of the pain policy. The VA applied code 5271 (ankle, limited motion) assigned a 10% rating. A higher rating under the 5271 code requires evidence of marked limitation of motion that is not supported by the record. The Board next considered the 5270 and 5272; however, there was no objective evidence of ankylosis or of poor weight bearing on the ankle. Given the record of evidence the Board could not find other applicable VARSD codes for consideration. The Board agreed that, at the time of separation, the CI had some limitation in portions of the ROM of his ankle; however, pain on use of the ankle was the predominant source of his disability. 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 right foot and 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. As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating right ankle and foot condition was operant in this case and the condition was adjudicated independently of that policy/instruction by the Board. In the matter of the right ankle and foot 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Right Foot and Ankle Pain 5099-5003 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120629, 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 AR20130007820 (PD201201162)

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                                                 

                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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