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AF | PDBR | CY2012 | PD2012 01306
Original file (PD2012 01306.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201306
BRANCH OF SERVICE: Army  BOARD DATE: 20130723
SEPARATION DATE: 20030725


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Guard/Reserve (AGR) CPT/O-3 (42B/Personnel Officer) medically separated for a right ankle condition. In December 2000, the CI injured her right ankle while running. The CI modified her activities, but her pain continued and in June 2002 she underwent surgery. Her pain persisted after surgery. The right ankle condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty. The CIs profile allowed for alternate aerobic events to satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The right ankle condition, characterized as “right ankle pain secondary to osteochondral fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “right ankle pain secondary to osteochondral fracture and surgery” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in her 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 right ankle condition is addressed below; and, 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 IPEB – Dated 20030402
 VA - (2 Mos. Pre) Effective 20060726
Condition
 Code Rating Condition Code Rating Exam
Right Ankle Pain secondary to osteochondral fracture/surgery 5271 10% Right Ankle Arthroscopy/Debridement of the Osteochondral Defect with Residual Scar 5271 10% 20030515
No Additional MEB/PEB Entries
 Other x 13 20030515
20030503
Rating: 10%
 Combined Rating: 30%
Derived from VA Rating Decision (VA RD ) dated 200 30726 ( most proximate to date of separation [ DOS ] ).



ANALYSIS SUMMARY:

Right Ankle Condition. The narrative summary (NARSUM) recorded the CI’s history of chronic right ankle pain associated with an inversion injury sustained in December 2000 while on active duty. The injury was initially diagnosed as a sprain treated conservatively without improvement. A magnetic resonance imaging study on 25 March 2001 showed an osteochondral lesion of the talar dome with associated ankle effusion that suggested inflammation of the tibiofibular and talofibular ligaments without evidence of ligamentous disruption. The CI underwent right ankle arthroscopic surgery in June 2002 and returned to full duty 30 days later. Physical therapy (PT) note date 7 August 2002 recorded right ankle range-of-motion (ROM) dorsiflexion at 5 degrees, plantar flexion of 40 degrees and inversion/eversion of 5 and 10 degrees, respectively. PT ROM recorded 3 September 2002 noted dorsiflexion at 30 degrees, plantar flexion of 35 degrees, and eversion/inversion of 10 and 20 degrees, respectively. The CI was able to bear full weight at that point. Radiographs showed healing in the ankle with noted increased bone density in the right talar dome compared to prior X-ray of June 2002. Follow up podiatry clinic visit noted CI condition was unchanged; she continued to report pain. Physical examination of the right ankle revealed tenderness to palpation and mild edema. At the MEB/NARSUM evaluation approximately 7 months prior to separation, physical examination noted right ankle dorsiflexion of 5 degrees with crepitus without significant associated pain on motion. Plantar flexion was recorded at 20 degrees. Podiatric NARSUM addendum dated 12 February 2003, 5 months prior to separation noted the surgical procedure was uncomplicated and all ligaments of the ankle were stable; however, the CI had not been able to perform the tasks of running, rucking, marching or other activities related to her job in the military. On physical examination of the right ankle, the examiner noted a well healed surgical scar with good vascularity of the feet. There was no evidence of neurological deficit and sensory function was intact. Tenderness to palpation of the right ankle was noted with pain elicited on maximum dorsiflexion and plantar flexion. ROM recorded 5 degrees of dorsiflexion without crepitation but associated with pain on motion. Plantar flexion was recorded at 20 degrees and inversion of 25 degrees. Gait was mildly antalgic. The MEB examiner noted a referral to PT for ROM recording. Physical therapy MEB note dated 5 March 2003 recorded ankle ROM right plantar flexion of 50 degrees, 60 degrees for the left, and right ankle dorsiflexion of 10 degrees, left 15 degrees. At the VA Compensation and Pension evaluation approximately 9 weeks prior to separation, physical examination noted the scar over the right ankle was well healed without any complications or disfigurement. There was no evidence of inflammation of the right ankle, and no muscle atrophy. Gait was normal; neurovascular and neurological examinations were normal. ROM of the right ankle recorded dorsiflexion of 20 degrees, plantar flexion at 45 degrees without pain, and no evidence of weakness, fatigue or incoordination with repetitive movement of the right ankle.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the right ankle pain condition 10% coded 5271 (limitation of motion, moderate). Likewise, the VA assigned an evaluation of 10% coded 5271, noting the evaluation was based on recent history of chronic treatment for painful and limited motion. The higher rating of 20% requires evidence of marked limitation of the ankle or ankylosis, not supported by the evidence of record. The Board considered the application of §4.40; however, noted it could not be applied in this case since there were no objective clinical findings of muscle atrophy, painful motion, or functional loss of the right ankle. There was no evidence of ankle instability to support the use of any other VARSD ankle code. 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 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. 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 right ankle pain secondary to osteochondral fracture 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
Right Ankle Pain Secondary to Osteochondral Fracture 5271 10%
RATING
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120710, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





 SFMR-RB                                                                         


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


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130019758 (PD201201306)

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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