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AF | PDBR | CY2013 | PD-2013-02228
Original file (PD-2013-02228.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02228
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20140731
SEPARATION DATE: 20050215


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (3E251/Pavements and Construction Craftsman) medically separated for chronic right ankle pain status post-surgery. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards. He was issued a permanent L4 profile and referred for a Medical Evaluation Board (MEB). The chronic right ankle pain condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic right ankle pain status post-surgery” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “Inability to run, walk, etc is more than 10% of life.”


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 chronic right ankle pain status post-surgery condition is addressed below; 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 20041216
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Ankle Pain Status Post-Surgery 5271 10% S/P Right Ankle Surgeries with Tenderness, and a Slight Right-Side Limp (also claimed as biometric shift in walking stride) 5271 10% 20050510
Scars, Right Ankle 7802 0% 20050510
No Other Items in Scope
 Other x 14 (Not in Scope) 20050510
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 50901 ( most proximate to date of separation ).


ANALYSIS SUMMARY:

Chronic Right Ankle Pain Status Post-Surgery Condition. The narrative summary dated 22 October 2004, noted the CI experienced a severe right ankle sprain in 2000. Initial ankle X-rays in January 2000 were normal. The CI continued with pain and reported problems with the ankle giving way and magnetic resonance imaging (MRI) of the ankle in October 2000 was normal. Per the CI, in a letter to the VA, he was referred for a second opinion after additional imaging studies, to include a bone scan and MRI and had arthroscopic surgery for debridement on 22 May 2001. According to notes in the service treatment record, the CI initially did well but in February 2003 (approximately 9 months later), an orthopedic clinic entry noted the CI continued to have pain with activity and another surgical procedure was planned. The CI had surgery to transfer a cartilage plug (from his knee) to an area of the of inner ankle joint with a cartilage defect (osteochondral lesion) (“OATS”) in March 2003. Three months after the OATS procedure the CI felt a “pop” and a repeat X-ray was taken as well as a computed tomography scan, which showed a 1 millimeter displacement of the plug with partial healing. At his follow-up visit in July 2003 the CI reported clicking of the ankle with range-of-motion (ROM). A diagnostic arthroscopy was performed with removal of excess soft tissue and loose cartilage. The surgical site was noted to be healed with a mild step-off. The procedure had stopped the joint from clicking. The CI was seen in January 2004, at which time he had full ankle ROM with minimal tenderness over the ankle joint but was cleared for all activities. Radiographs at that time showed a fully healed and well preserved ankle joint. In March 2004, the CI reported another injury while running, with ankle bruising but X-rays at the time were normal. He reported being able to walk since then, but could not perform impact activities without pain. The CI was expected to improve, but 2 months later he reported that he continue to experience problems. On examination he had tenderness to palpation, ankle dorsiflexion (DF) of 10°, slight instability and minimal crepitus. Medical separation was recommended. At the MEB examination on 22 October 2004, approximately 3 months prior to separation, the CI reported right ankle pain that affected his ability to run. The MEB physical examination noted right ankle ROM of DF of “to 100°” or 10° (normal 20°) and plantar flexion (PF) of “from 90° to 75°” or 25° (normal 45°), with tenderness to palpation of the inner aspect of the ankle and slight instability noted.

At the VA Compensation and Pension (C&P) examination on 10 May 2005, 3 months after separation, the CI reported daily usage of anti-inflammatory medication for his right ankle pain. The examiner noted functional impairment from decreased ROM of the ankle. The CI was noted to have a slight right-sided limp. Bilateral lower extremity strength, sensation and reflexes were intact. The right ankle was slightly swollen and diffusely tender with ROM noted to be limited by pain with DF of 10° and PF of 30°. Right ankle X-rays showed intact surgical hardware and “minimal” post-traumatic degenerative changes of the tibia at the inner aspect of the right ankle (medial malleolus).

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA both rated the chronic right ankle pain at 10%, coded 5271 (limited ankle motion). At the time of separation the CI had persistent ankle pain with activity, with moderately limited ROM and minimal degenerative changes noted on imaging. The Board considered whether a higher evaluation than 10% was achieved with code 5271, or any other applicable code IAW VASRD 4.71a. The 5271 rating criteria are subjective and specified as “moderate” for a 10% rating and “marked” for a 20% rating. The Board agreed that the ankle ROM in evidence was moderate and did not achieve a 20% rating. The Board considered coding as 5273 (ankle malunion), which also has subjective rating criteria with a 10% rating reflecting a “moderate deformity,” and a 20% rating, “marked deformity.” The Board agreed that the evidence in the record of “a mild step-off” noted on arthroscopy and a well healed, well maintained ankle joint noted on X-rays did not support characterizing the CI’s ankle as having a “marked deformity.” The Board reviewed coding under 5262 criteria (analogous to tibia, fibula impairment) and the Board majority opined that this approach was not supported by the evidence in record. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic right 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 chronic right ankle pain condition and IAW VASRD §4.71a, by a majority vote, the Board recommends no change in the PEB adjudication. The single voter for dissent did not elect to submit a minority opinion. 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 20131031, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB
Dear XXXXXXXXXXXXXX:

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-02228

         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

                                                               Sincerely,






 XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

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