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AF | PDBR | CY2012 | PD2012 01396
Original file (PD2012 01396.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201396
BRANCH OF SERVICE: Army  BOARD DATE: 20130508
SEPARATION DATE: 20010914


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11M/Infantryman) medically separated for left ankle pain condition. The CI sustained a sprain injury to his left ankle while he was playing softball in October 2000. He was started on range-of-motion (ROM) exercises and progressive strengthening by physical therapy. 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 referred for a Medical Evaluation Board (MEB). The left ankle pain condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated the left ankle pain condition as unfitting, rated 10%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. The CI made no appeals, and was medically with a 10% disability rating.


CI CONTENTION: “For the past years my ankle/leg has been hurting to a point that at times, I am unable to walk or bend my left leg. I continue to have ringing in my ears. Also, after being out a dr. noticed that I have a crushed disk that was causing me pain in my back. When discharged examinaner, there were no x-rays taken.”


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 left ankle pain condition is addressed below and the contended conditions, ringing in the ears and the low back pain are not 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 respective Service Board for Correction of Military Records.



RATING COMPARISON:

Service IPEB – Dated 20010816
 VA - (1 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Ankle Pain, secondary to Posttraumatic Arthritis
 5010 10% Residuals of Multiple Sprains and Avulsions, Left Ankle 5299-5271 10%* 20010827
No Additional MEB/PEB Entries
 Other x 4 20010827
Combined: 10%
 Combined: 10%
*NOTE – Per VARD dated 20021106/20021218 condition rating was changed to 100% from 20011102-20020201 the then to 20% effective 20020201.

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continues to burden him but must emphasize that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Left Ankle Pain Condition. The narrative summary (NARSUM) notes documented the CI sustained a severe ankle sprain while playing softball in October 2000. This was treated with splinting and immobilization for 4-6 weeks, then subsequent ROM and progressive strengthening exercises with physical therapy. Despite treatment the CI continued to have ankle pain and instability symptoms which culminated in a permanent profile March of 2001. The profile limitations included no forced running or marching, alternate physical fitness testing authorized, able to march 1 mile and lift 50 pounds. The commander’s statement corroborated his injury and limitations.

At the MEB exam, the CI reported ankle pain that radiated to the mid-calf with notable swelling as the day progressed and all symptoms worsened with prolong walking. He also reported he had a crack on the left side of his ankle and the ligaments tore pieces of bone off the right side. The NARSUM orthopedic physical exam demonstrated tenderness of the medial and lateral ankle, mild swelling of the ankle joint, mild increase talar tilt (sign of ligament instability), no evidence of anterior draw (sign for ligament stability) and normal neuromuscular findings. The exam was silent to gait. X-rays revealed degenerative changes in both the medial and lateral aspects of the tibiotalar joint. At the VA Compensation and Pension (C&P) exam, a month prior to separation, the CI additionally reported he had an original injury to his left ankle prior to service and then re-injured his ankle while in Service. He reported symptoms of instability with easy twisting of the ankle when walking on uneven surfaces. He also reported using an ankle brace occasionally while walking and running. The C&P exam demonstrated no swelling or inflammation, no tenderness, and that he was able to rise on heels and toes and stand and hop on one foot without evidence of discomfort or loss of mobility. No additional X-rays were completed.

The goniometric 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)
 Ortho ~ 06 Mo. Pre-Sep MEB ~ 02 Mo. Pre-Sep VA C&P ~ 01 Mo. Pre-Sep
Dorsiflexion (20 Normal)
 5 5 20
Plantar Flexion (45)
 40 30 45
Comment
 Silent to painful motion
§4.71a Rating
 20% 20% 10 %

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA chose different coding options for the condition but this did not bear on rating and both were IAW §4.71a—Schedule of ratings–musculoskeletal system. The PEB’s DA Form 199 reflected application of the USAPDA pain policy for rating and its 10% determination is consistent with §4.71a standards under code 5010 (traumatic arthritis) which defaults to the 5003 diagnostic code (arthritis, degenerative) . There is no evidence of documentation of incapacitating episodes which would provide for additional or higher rating under this code. The VA assigned a 10% rating coded analogous to 5271 (ankle, limited motion of) for moderate limited motion of the ankle. The 5271 diagnostic code allows either a 10% for moderate limitation of motion or 20% for marked limitation of motion and relies on the rater’s opinion regarding degree of severity, as there are no specified measured degrees of ROM impairment for either rating. The Board notes there is a clear disparity in the NARSUM and VA exams which occurred prior to separation. The Board notes an other corroborating orthopedic exam which is consistent with the NARSUM exam and additionally notes these exams are completed by an orthopedic specialist therefore assigns th e NARSUM exam more probative value. The Board next considered the VA’s chosen code for marked limitation of motion for a higher rating. Based on ROM criteria alone, the NARSUM orthopedic exam, and the corroborating orthopedic exam, reflects a near absence of dorsiflexion. The medical member discussed during most activities of daily living, only a partial ROM is required: walking on an even surface (10-15 degrees plantar flexion and 10 degrees dorsiflexion) in the absence of consideration of navigating stairs which would require more . The Board notes the NARSUM dorsiflexion exam is actually less than the necessary 10 degrees required. Therefore based on the near absence of dorsiflexion alone the Board agreed the left ankle condition meets the 20% rating f or marked limitation of motion. There is no viable approach to a higher rating or additional rating for the left ankle which is countenanced by the VAS RD in the absence of ankylosis or peripheral nerve impairment. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the 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. As discussed above, PEB reliance on the USAPDA pain policy for rating the left ankle pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the left ankle pain condition, the Board unanimously recommends a disability rating of 20%, coded 5010-5271 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board 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
Left Ankle Pain Condition
 5010-5271 20%
COMBINED
 20%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120726, 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), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20130010840 (PD201201396)
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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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