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AF | PDBR | CY2013 | PD-2013-01845
Original file (PD-2013-01845.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-01845
BRANCH OF SERVICE: Army  BOARD DATE: 20140821
SEPARATION DATE: 20040123


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (88M10/Motor Transportation Operator) medically separated for left ankle condition. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The left ankle condition, characterized as “left ankle pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated left ankle pain as unfitting rated 10%, with ap plication of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “My ankle still causes problems with foot wear as well as continuous to roll all the time, which in turn cases me to walk different which affects my knees, back, and hips.”


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 condition is addressed below. The contended, knees, back and hips conditions, were not identified by the MEB or PEB; thus, they are not within the DoDI 6040.44 defined purview of the Board. These, and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records. The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden her; but, it must emphasize that the Disability Evaluation System 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.


 RATING COMPARISON :

Service IPEB – Dated 20031217
 VA* - (On DOS)
Condition
 Code Rating Condition Code Rating Exam
Left Ankle Pain 5271 10% Residuals of Left Ankle Injury… 5271 10% 20040123
Other x 0 (Not in Scope)
 Other x 3 (Not in Scope) 20040123
Combined: 10%
 Combined: 10%
*Derived from VA Rating Decision (VARD) dated 200 40511 (most proximate to date of separation (DOS))


ANALYSIS SUMMARY:

Left Ankle Pain. The CI had a surgical reconstruction of the left ankle (Brostom procedure) on 23 April 2003 for a year long history of left ankle pain and instability which had not resolved with conservative measures. She did not cite a specific incidence of trauma. Despite rehabilitation in physical therapy, she continued to have pain with activity and did not improve sufficiently to meet duty requirements. She was issued a permanent L3 profile for post-operative left ankle pain on 29 October 2003 and an MEB initiated. The MEB narrative summary examination was dated 29 October 2003, approximately 6 months prior to separation and dictated by the treating orthopedic surgeon. The CI reported that she had injured the ankle a year previously, but had only been having problems with pain and instability since January. She endorsed continued pain with any activity. On examination, sensation and motor function were preserved. The incision was well healed and her gait normal. The range-of-motion (ROM) (charted below) was reduced, but identical to the measurements of the unaffected right side for plantar flexion (toes down), eversion (sole out) and inversion (sole in). Dorsi-flexion (toes up) was reduced 5 degrees on the left compared to the right, 10 and 15 degrees, respectively. Both less than the VA normal value of 20 degrees. At the MEB medical examination (DD Form 2808) dated 18 November 2003, approximately 5 months prior to separation, the examiner documented decreased ROM of the ankle without further detail. She was also noted to have mildly symptomatic pes cavus (high arch). This had not been documented by the orthopedist although it had been cited by a podiatrist in January 2002. The commander cited duty impairment from her ankle problems in the 14 November 2003 assessment. The VA Compensation and Pension examination was accomplished 23 January 2004, approximately 3 months prior to separation. The CI reported that she could walk half a mile prior to the onset of ankle pain and could work out on an elliptical trainer for 30 minutes without difficulty. While she still had pain, she no longer noted instability. On examination, her posture and gait were normal. The ROM was reduced as charted below; the unaffected right ankle ROM was not recorded. She had normal strength of the ankle and foot and was able to accomplish toe, heels and tandem walk. 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)		 PT 4 Mo. Pre-Sep NARSUM 2.9 Mo. Pre-Sep VA C&P (On DOS)
Dorsiflexion (20 Normal) 5 10 10
Plantar Flexion (45) 65 40 40
Comment Right ankle dorsiflexion 15 degrees Nml gait, strength, and toe/heel/tandem walk
§4.71a Rating 10 % PEB 10 % VA 10%
invalid font number 31502 IAW §4.59 (Painful motion)

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA both rated the left ankle at 10% using the VASRD code 5271 (limited motion of the ankle). The Board considered the findings and found no route to a rating higher than that adjudicated by both the PEB and VA. It noted that the VA continued the 10% rating on review in the 13 March 2009 rating decision. 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 left ankle 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 ankle 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131001, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                                   
XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150004688 (PD201301845)

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                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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