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AF | PDBR | CY2013 | PD-2013-02258
Original file (PD-2013-02258.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02258
BRANCH OF SERVICE: Army  BOARD DATE: 20150203
SEPARATION DATE: 20071208


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Wheeled Vehicle Mechanic) medically separated for a left ankle condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The left ankle condition, characterized as “chronic pain syndrome involving the left ankle retained hardware in the left leg,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The informal PEB adjudicated “chronic left ankle pain…” as unfitting, rated 0%, with likely application of AR635-40. The CI made no appeals and was medically separated.


CI CONTENTION: “Because of pain in lower extremities I have gained weight and suffer from sleep apnea, and from MEDs I have suffered from bowl [sic] problem.”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

Service IPEB – Dated 20051004
 VA – (1 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Ankle Pain 5099-5003 0% Left Ankle Injury, Residuals of Left Fibular and Tibial Fractures 5262 10% 20051108
Other x 0 (Not In Scope)
 Other x 7
Combined: 0%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 20051220 ( most proximate to date of separation [ DOS ] ).



ANALYSIS SUMMARY:

Left Ankle Condition. The CI incurred a fracture of the tibia and fibula bones just above the left ankle in September 2004. He underwent an initial surgery to stabilize the fractures and two additional procedures for adjustment and removal of hardware. Satisfactory healing of the fractures was noted at the time of hardware removal in January 2005 (intramedullary nail in the tibia was not removed). X-rays healed fractures with retained intramedullary nail in the tibia. The CI had complaint of left ankle pain following recovery from surgery. Magnetic resonance imaging (MRI) of the left ankle on 9 August 2005 was normal (normal bones, joint surface, ligaments, and tendons). At the time of the MEB narrative summary examination on 25 August 2005, the healing of the fractures was characterized as excellent. However, the CI had complaints of chronic left ankle pain interfering with performance of duties. On examination, left ankle range-of-motion was dorsiflexion of 10 degrees (compared to 15 degrees on the right ankle; normal 20 degrees) and plantar flexion of 45 degrees (compared to 45 degrees on the right; normal 45 degrees). Inversion and eversion was the same in both ankles. There was no instability or subluxation of the left ankle joint. At the time of the VA Compensation and Pension (C&P) examination on 8 November 2005, a month prior to separation, the left ankle dorsiflexed to 5 degrees (compared to 5 degrees on the right), and plantar flexed to 40 degrees (compared to 45 degrees on the right).

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 0% (coded 5099-5003; degenerative arthritis) citing pain but absence of significant limitation of motion and absence of joint instability. The VA rated the left ankle 10% (coded 5262; impairment of tibia and fibula) citing functional loss due to pain. The ankle limitation of motion at both the MEB and the VA C&P examination was slight and did not approach the moderate limitation required for a 10% rating under diagnostic code 5271 for limitation of ankle motion. The MRI of the left ankle was normal and the CI’s ankle pain was attributed to the fracture of the tibia and fibula. Therefore the Board considered rating using 5262, impairment of the tibia and fibula due to non-union or malunion. Although the tibia and fibula healed without residual non-union or malunion the CI experienced some residual pain affecting the ankle. The Board agreed the functional loss supported a 10% rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left ankle pain following fracture of the distal tibia and fibula (5299-5262).


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. In the matter of the left ankle pain following fracture of the distal tibia and fibula condition, the Board unanimously recommends a disability rating of 10% coded 5299-5262 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 Following Fracture Of The Distal Tibia And Fibula 5299-5262 10%
COMBINED 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131025, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record


                                   
XXXXXXXXXXXXXXX
President
DoD 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, AR20150009547 (PD201302258)


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 10% 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              XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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