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AF | PDBR | CY2013 | PD-2013-02076
Original file (PD-2013-02076.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02076
BRANCH OF SERVICE: Army  BOARD DATE: 20141107
SEPARATION DATE: 20050626


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31B/Military Police) medically separated for a right ankle condition. The right foot condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The right foot condition, characterized as “chronic postoperative pain of the right foot, following a calcaneocuboid arthrodesis”, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “limited range of motion right ankle status post calcaneocuboid arthrodesis for longstanding ankle instability” as unfitting, rated at 10% with likely application of the Veteran s Affairs Sche d ule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Right Ankle, Right Shoulder, Bilateral Bunions, Scars, residuals, Right Ankle, Cocydynia/Right. Sacro-iliac Joint Dysfunction, Upper Respiratory Infections, Allergic Rhinitis” [sic]


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. The CI’s contention for the right shoulder, bilateral bunions, scars, residuals, right ankle, cocydynia/right sacro-iliac joint dysfunction, upper respiratory infections, and allergic rhinitis conditions were not identified by the PEB, thus 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 Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20050402
 VA - (2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Ankle 5271 10% Right Ankle 5271-5024 10% 20050503
Other x 0 (Not in Scope)
 Other x 6 20050503
Rated: 10%
 Combined: 40%
* Derived from VA Rating Decision (VA RD ) dated 200 50714 (most proximate to date of separation)


ANALYSIS SUMMARY

Right Ankle Condition. In June 2004, the CI sustained a right ankle sprain with initial X-rays images revealed no bony fractures. The CI was able to complete her physical training test in July 2004 nevertheless later that same year; she was diagnosed with chronic foot pain syndrome and was profiled in September 2004. An orthopedic evaluation dated 1 September 2004; the examiner diagnosed the CI’s condition as chronic right ankle sprain with chronic tendonitis and further opined [a] “full recovery with nonsurgical treatment”. A Bone scan of the ankle obtained on 14 September 2004, revealed possible “contusion of the right mid-foot” prompting the examiner to requested further diagnostic radiographic studies. A CT scan of the right foot and ankle taken on 23 September 2004, were essentially normal. In October 2004, the CI received significant but temporary, relief of her ankle pain with an [steroid] injection to the ankle in the area between the heel bone (calcaneus) and first ankle bone (cuboid). A clinical diagnosis of “instability” of this joint was made and magnetic resonance imaging (MRI) was ordered for further definition.

The MRI of the ankle obtained on 16 November 2004, revealed a small joint effusion without reports of other pathologies. Surgical stabilization of the presumed unstable joint was undertaken in January 2005 with the placement of a screw between the calcaneus and cuboid bones (calcaneo-cuboid arthrodesis). This surgery was accomplished through a six inch incision extending from above the outside ankle bone of the right foot into the mid-foot area. Postoperatively, there was some [tissue] breakdown noted of the incision (maceration) that healed with wound care and several small peri-incision residual “granuloma” (lumped-up scar areas). Post-operative X-rays images showed satisfactory healing of the involved bones and screw.

At the MEB NARSUM dated 4 April 2005 (3 months prior to separation) completed 3 months post-operative, the CI reported that her right foot pain was unresolved; the ability to ambulate with a soft shoe and ankle brace; and that her pain was controlled with non-narcotic medication but she has been pain free for over a week. On physical examination, the examiner noted that the right foot was without edema (swelling), the surgical incision appeared healed with “healed granulomas” tissue present. Gentle palpation of the surgical site produced significant pain. The neurovascular exam was normal. The NARSUM range-of-motion (ROM) dated 21 April 2004 was performed by a podiatrist that recorded an ankle dorsiflexion of 10 degrees and plantar flexion of 20 degrees (normal 20 degrees and 45 degrees, respectively).

At the VA Compensation and Pension (C&P) examination performed on 3 May 2004 (5 months post operatively) the CI reported that she continue to have right ankle pain that was aggravated by walking. On examination the [CI’s] gait was normal. The surgical scar was healed but tender to palpation. ROM of the ankle was 15 degrees dorsiflexion and 30 degrees plantar flexion with pain. The neurovascular examination was normal.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and the VA both rated the ankle condition at 10% coded 5271 (ankle limitation of motion, moderate) with the VA adding the second analogous code, 5024 (tenosynovitis). A higher rating of 20% under this code requires the limitation of motion to be “marked”. The Board agreed that the ankle condition rose to the level of 10% for painful motion under VARSD criteria §4.40 and §4.59. The Board also determined that the condition was moderate but supported no higher rating than 10% under codes 5272 (limited range of motion), 5283 or 5284 (foot or foot bone injury) nor founded any evidence to support a rating under VARSD criteria §4.124 (neurologic injury ) or criteria §4.73 (muscle injury). The Board considered an additional rating under code 7801 (painful scars), however, the Board was unable to distinguish between the pain that was caused by the scar from the operative site pain. The Board thus, was unable to recommend an additional rating consideration IAW §4.14 (avoidance of pyramiding) and was unable to find pathways to a higher than 10% rating for the ankle condition. 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 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 right 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 recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131024, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX, AR20150002645 (PD201302076)

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

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