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AF | PDBR | CY2012 | PD2012 01371
Original file (PD2012 01371.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD1201371        
BRANCH OF SERVICE: Army        BOARD DATE: 20130919
SEPARATION DATE: 20020313                         


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B1P, Infantry) medically separated for a left foot and ankle condition. The CI was injured in May 1998 when he fell down some stairs at Fort Benning, Georgia. He twisted his ankle and heard an audible crepitus and snapping and had subsequent weakness in his ankle and foot. Since that time, he continued to have recurrent injuries of ankle twisting with sprains due to the residual weakness. The left foot and ankle 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 left foot and ankle condition, characterized as left flexor hallucis longus synovitis with persistent pain after exploration and debridement was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AR 40-501. No other conditions were submitted by the MEB. The IPEB adjudicated left foot pain at the first metatarsophalangeal joint along the posterior aspect of the medial malleolus as unfitting rated 10%. The CI appealed to the Formal PEB (FPEB) which did not affirm the IPEB rating. The FPEB rated the left foot pain at the first metatarsophalangeal joint along the posterior aspect of the medial malleolus as unfitting, rated 20% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).


CI CONTENTION: “Continuing pain and degeneration of foot and knee pain resulting from abnormal gait.”


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 Service rating for the unfitting left foot and ankle condition is addressed below. No other conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions outside the Board’s defined scope of review may be eligible for consideration by the Board for Correction of Military Records.


RATING COMPARISON:

Service FPEB – dated 20011217
 VA - (~14 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Foot Pain at The First Metatarsophalangeal Joint Along The Posterior
Aspect of The Medial Malleolus.
 5020-5003 20% Left Foot Flexor Hallucis Valgus Synovitis with Instability and Post-Traumatic Changes in Left Ankle with Moderate Limitation of Motion 5020-5271 20% 20020110
No Additional MEB/PEB Entries
 0% x 4 / Other x 3 20020110
Combined: 20%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 20404 ( most proximate to date of separation [ DOS ] )


ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed by the CI regarding the impairment with which his left foot and ankle condition continues to burden him, and the significant impact it has had on his quality of life. It is noted for the record that the Board is subject to the same laws for Service disability entitlements as those under which the Disability Evaluation System (DES) operates. The DES has neither the role nor the authority to compensate service members for future severity or potential complications of conditions. That role and authority is granted to the Department of Veterans Affairs. The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation. While the DES considers all of the CI's medical conditions, compensation can only be offered for those conditions that cut short a service member’s career, and then only to the degree of severity present at the time of separation. The Board cannot consider the CI’s knee pain, because knee pain was not included as an MEB/PEB condition. The DVA, however, is empowered to compensate for any service-connected condition and to periodically reevaluate for the purpose of adjusting the CI’s disability rating should the degree of impairment change over time.

Left Foot and Ankle Pain. In May 1998, the CI was injured when he fell down some stairs at Fort Benning, Georgia. After that, he suffered additional injuries to his left lower extremity (LLE). By October 2000, his level of activity was reduced due to worsening pain in his left foot and ankle. In March 2001, he had ankle surgery at Eisenhower Army Medical Center. Following surgery, he continued to have LLE pain and an MEB was initiated. His MEB narrative summary was dictated in October 2001. At the MEB physical exam (PE), the CI reported difficulty with going down stairs and with extensive standing or walking. On PE, the surgical scar was well healed. There was tenderness to palpation (TTP) along the scar, and tenderness also on the volar aspect of the first metatarsophalangeal (MTP) joint. Left ankle range of motion (ROM) was measured, and is summarized in the chart below. The examiner’s diagnosis was Flexor hallucis longus (FHL) synovitis, with persistent pain after exploration and debridement.

In January 2002, 2 months prior to separation, the CI had a VA Compensation and Pension (C&P) exam. At that time, he reported constant pain, and limited ROM. Posture was normal. PE revealed a bulge on the inner aspect of the left foot which was tender to deep pressure. There was no heat or redness. He was unable to stand on the left foot with the right foot elevated. The two ankle ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized below.

Left Ankle ROM
 MEB ~5 M os . Pre-Sep
 (200 11015 ) 		VA C&P ~ 2 M os . P re - Sep
 (200 20110 )
Dorsiflexion (20 ⁰ is n ormal)
 15 ⁰ 15 ⁰
Plantar Flexion (45 ⁰ is normal )
 30 ⁰ 30 ⁰

The Boar d directs attention to its rating recommendation based on the above evidence. The Army F PEB combined the CI’s left foot and ankle problems into a single unfitting condition characterized as: l eft foot pain at the first MTP joint, along the posterior aspect of the medial malleolus. The condition was coded 50 20-5003 and rated at 2 0%. The VA also bundled the two pain problems and rated them 20%. The Board evaluated whether or not it was appropriate for the two problems to be “bundled” together. The Board must determine if th is approach of combining the conditions under a single rating was reasonably justifie d in lieu of separate ratings. The Board must apply separate codes and ratings in its recommendations if compensable ratings for each invalid font number 31506 condition are achieved IAW the VASRD . If the Board judges that two or more separate ratings are warranted, however, it must sat isfy the requirement that each unbundled condition was separately unfitting. After due deliberation, the Board agreed that the evidence did not support a conclusion that each of the pain condition s , separately, would have rendered the CI unable to perform h is required military duties . Accordingly, the Board does not recommend a separate disability rating for the two pain problems. It is reasonably justified for the left ankle problem ( medial malleolar pain) and the left foot problem ( first MTP joint pain) to be “bundled” together , and treated as a single unfitting left lower extremity (LLE) pain condition .

Based on the evidence in the treatment record, the Board unanimously agreed that the CI’s LLE condition was best described as moderate. There was insufficient evidence to support classifying the condition as severe. After due deliberation, the Board determined that a separation disability rating of 20% was warranted, due to the LLE condition. The Board tried to find a path to a higher rating, using other codes which could be applied to the pain condition. The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a significantly disabling abnormality which would justify a rating higher than 20%. Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), §4.7 (higher of two evaluations), and §4.14 (avoidance of pyramiding), the Board concluded that there was insufficient cause to recommend a change in the FPEB adjudication for the LLE 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 LLE pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the FPEB 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
Left Foot and Ankle Pain, at First MTP Joint and Medial Malleolus
 5020-5003 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120727, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





                          
         XXXXXXXXXXXXXXXXXXX, DAF
         President
         Physical Disability Board of Review





SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB / XXXXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXX, AR20130021918 (PD201201371)


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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