Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02352
Original file (PD-2013-02352.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02352
BRANCH OF SERVICE: Army          BOARD DATE: 20150716
SEPARATION DATE: 20040601


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Unit Supply Specialist) medically separated for left ankle pain. 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 pain status post reconstructive surgery” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (plantar fasciitis) as medically acceptable for PEB adjudication. The Informal PEB (IPEB) adjudicated “chronic left ankle pain, status post reconstructive surgery” as unfitting, rated 10%, c iting application of the US Army Physical Disability Agency (USAPDA) pain policy. The remaining condition was determined to be not unfitting . The CI appealed the decision but waived a formal hearing. The PEB affirmed the findings and ratings, and the CI and was medically separated.


CI CONTENTION: He believes his ankle condition deserved a higher Service rating and that other conditions were not considered. His complete submission is at Exhibit A.”


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 :

IPEB – Dated 20040402
 VA* - (~8 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Left Ankle Pain, Status Post Reconstructive Surgery 5099-5003 10% Reflex Sympathetic Dystrophy Ankle, Left 5271 20% 20050121
Plantar Fasciitis Not Unfitting Plantar Fasciitis with Left Calcaneal Spur 5284-5276 0%
Other MEB/PEB Conditions x 0 (Not In Scope)
 Other x 1
RATING: 10%
 RATING: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 50727 ( most proximate to date of separation [ DOS ] ) .

ANALYSIS SUMMARY:

Chronic Left Ankle Pain. The narrative summary (NARSUM) noted the CI injured his left ankle during a physical fitness run when he stepped in a hole and twisted the ankle in June 2003. Conservative treatment did not resolve the pain and magnetic resonance imaging in August 2003 reportedly showed evidence of plantar fasciitis (PF) (inflammation of the sole of the foot), but no ankle pathology, except mild evidence of degenerative changes. However, a diagnostic arthroscopy on 10 November 2003 noted ankle instability and the CI underwent reconstruction of the lateral ankle ligament. At a physical therapy (PT) evaluation on 13 January 2004, 2 weeks before the MEB exam, the CI was still in a boot following surgery. Ankle range-of-motion (ROM) was dorsiflexion (DF) of 0 degrees (normal 20); plantar flexion of 20 degrees (normal 45) and there was weakness of the ankle, greatest with plantar flexion, graded 2/5. On 23 January 2004, the DD Form 2808, Report of Medical Examination, noted a swollen left ankle. At the MEB examination on 27 January 2004, 4 months before separation, the CI reported ankle pain and instability after surgery. The MEB physical exam noted a well-healed scar over the ankle. There was tenderness to palpation (TTP) of the Achilles tendon at the back of the heel, and swelling but no TTP over the lateral ankle. Ankle ROM was DF 5 degrees and plantar flexion 35 degrees, with pain with all ROM. The same ankle weakness noted by PT above was observed and testing for ankle instability was negative.

At the VA Compensation and Pension (C&P) examination 21 January 2005, 8 months after separation, the CI reported constant left ankle pain. There had been no periods of incapacitation in the past year due to the ankle condition. The CI was noted to require a brace for ambulation to “stabilize the ankle and keep it from inverting.” The exam noted an antalgic gait favoring the left ankle. The ankle was noted to be TTP diffusely over the ligaments of the lateral ankle with “minimal laxity.” Ankle ROM was DF of 5 degrees and plantar flexion of 20 degrees. There was no additional loss of ROM with repetition, but there was increased pain with repetition noted. Left ankle X-rays were normal.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 10%, coded 5099-5003 (analogous to degenerative arthritis), and cited the USAPDA pain policy. The VA rate it 20%, coded 5271 (limited ankle motion). The Board noted that the rating criteria of 5271 are subjective with 10% for “moderate” and 20% for “marked” limited ankle ROM. The Board agreed that the evidence in record of decreased painful ROM, an abnormal gait, and use of a brace for a stabilization supports a 20% rating, coded as 5271 for “marked” limited ankle ROM IAW VASRD §4.40. The Board noted a 20% rating is the highest evaluation for this code and reviewed to see if a higher evaluation was achieved with any other applicable code. There was no evidence of ankylosis of the ankle joint or any other ratable impairment, therefore members concluded the ankle condition met a 20% rating and no higher. 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 condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the PF condition was not unfitting. The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The CI was evaluated on 25 June 2003 for the ankle/foot injury noted above and was diagnosed with PF. The CI was given anti-inflammatory medication, advised to do ice massage and stretching exercises, and was placed a temporary profile. Notes in the STR indicated the CI had PT for the PF and was given custom orthotics with improvement. At an orthopedic follow-up, the CI reported the PF pain was “nearly gone” and the diagnostic arthroscopy note on 10 November 2003 indicated that the PF had improved with PT. The MEB exam noted tenderness of the left plantar fascia that was medically acceptable. The PF condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards. There was no performance-based evidence from the record that the PF condition significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the PF condition and so no additional disability rating is recommended.


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. As discussed above, PEB reliance on the USAPDA pain policy for rating the ankle condition was operant in this case and the condition was adjudicated independently of that policy by this Board. In the matter of the left ankle condition, the Board unanimously recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a. In the matter of the contended PF condition, the Board unanimously agrees that it cannot recommend it for additional disability rating. 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:

CONDITION VASRD CODE RATING
Chronic Left Ankle Pain, Status Post Reconstructive Surgery 5271 20%
RATING 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131111, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record


XXXXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX , AR20150012438 (PD201302352)
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                                                  XXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA



Similar Decisions

  • AF | PDBR | CY2014 | PD-2014-01364

    Original file (PD-2014-01364.rtf) Auto-classification: Approved

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. Right Ankle Condition . At the MEB examination on 23 November 2005, 4 months prior to separation, the CI reported constant right ankle pain worsened by weight bearing activities or twisting of the ankle treated with...

  • AF | PDBR | CY2014 | PD-2014-01985

    Original file (PD-2014-01985.rtf) Auto-classification: Denied

    According to the VASRD rules for rating the spine in effect at the time of separation thoracic and lumbar spine conditions coded IAW §4.71a are provided a single disability rating and thus the thoracic DDD and the lumbago (listed by the PEB as separate conditions) are subsumed in the §4.71a rating that follows. Since the disability due only to the left foot cannot be isolated by the clinical evidence or from the fitness implications of the bilateral condition, the Board consensus was that...

  • AF | PDBR | CY2013 | PD-2013-01652

    Original file (PD-2013-01652.rtf) Auto-classification: Approved

    The PEB adjudicated “bilateral ankle pain and instability post Brostrom reconstruction” and “chronic foot pain due to plantar fasciitis” as unfitting, rated 0% and 0%, with likely application of the VA Schedule for Rating Disabilities (VASRD).The PEB found the referred left knee condition as not unfitting. Pre-Separation) ConditionCodeRatingConditionCodeRatingExam Chronic Foot Pain due to Plantar Fasciitis5399-53100%Left Foot Plantar Fasciitis with Pes Cavus5299-502010%20040205Right Foot...

  • AF | PDBR | CY2012 | PD2012-00214

    Original file (PD2012-00214.pdf) Auto-classification: Denied

    Post-Separation) – All Effective Date 20050501 Code Rating Condition Code Rating Exam 5099-5003 20% Category 2 S/P Right Ankle Sprain w/ Residual FX & Ligament Rupture; Posttraumatic Osteochondritis, Posttraumatic Arthrosis 5271 20% 20050808 No Additional MEB/PEB Entries Combined: 20% Dysthymic Disorder . Both of the PEB right ankle conditions were considered in rating the right ankle condition. 3 PD1200214 RECOMMENDATION: The Board, therefore, recommends that there be no...

  • AF | PDBR | CY2011 | PD2011-00629

    Original file (PD2011-00629.docx) Auto-classification: Denied

    The CI underwent three complex surgeries to correct the bilateral ankle pathology, however, he continued with pain stiffness and limited motion in both ankles and feet. The Board does not have the authority under DoDI 6040.44 to render fitness or rating recommendations for any conditions not considered by the DES. The Board does not have the authority under DoDI 6040.44 to render fitness or rating recommendations for any conditions not considered by the DES.

  • AF | PDBR | CY2012 | PD-2012-00025

    Original file (PD-2012-00025.rtf) Auto-classification: Approved

    Right Wrist Condition . The CI was evaluated by multiple orthopedic specialists and after the MEB examination underwent repeat surgery for the OCD on 3 February 2005.A PT note on 15 August 2005 noted the CI reported doing “pretty well,” with improved ability to walk and decreased pain.At the MEB examinationthe CI reported right ankle pain. At a VA outpatient physical medicine evaluation on 9 November 2005, 2 months after separation, the CI reported right ankle pain despite two surgeries...

  • AF | PDBR | CY2009 | PD2009-00573

    Original file (PD2009-00573.docx) Auto-classification: Denied

    Bilateral Ankle and Foot Pain (including Scars) Conditions : The PEB found the CI unfit for: “Bilateral foot and ankle pain with history of bilateral surgically treated clubfeet, right calcaneonavicular coalition and resection of left calcaneonavicular coalition.” The PEB combined the Left ankle, Left foot, Right ankle, and Right foot as a single unfitting condition, coded as 5271 (VA Rating Code “5271 Ankle, limited motion of:”) and rated 10% (“Moderate”) with possible use of SECNAVINST or...

  • AF | PDBR | CY2012 | PD2012-00393

    Original file (PD2012-00393.docx) Auto-classification: Denied

    (2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service (i.e., chronic right ankle pain following ankle strain); or, when requested by the CI, those conditions “identified but not determined to be unfitting by the PEB”. The ratings for unfitting conditions will be reviewed in all cases. RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation...

  • AF | PDBR | CY2013 | PD-2013-02247

    Original file (PD-2013-02247.rtf) Auto-classification: Denied

    SEPARATION DATE: 20070430 Members agreed that the evidence supports a 20% rating for Group XI moderately severe muscle disability due to cardinal signs and symptoms of muscle disability of marked muscle atrophy, loss of soft tissue, and weakness on examination and lowered threshold of fatigue, fatigue-pain, and uncertainty of movement/incoordination with repetitive ROM or extended standing and walking, and loss of power due to posterior scar tissue.The Board again considered the normal gait...

  • AF | PDBR | CY2012 | PD2012-01227

    Original file (PD2012-01227.pdf) Auto-classification: Denied

    The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. Pre-Sep Right Left -10* 25 2 35 Comment *“Lacks 10⁰ to 0/Neutral DF” Left 10 25 Right 12 35 L ankle w/ mild generalized tenderness; Drawer sign (-); mild valgus-varus laxity; strength 3-4/5; Neurovascular intact; 1+ foot & ankle edema; TTP Left 0-20 0-45 Right NE Normal gait; no painful motion, edema, instability or weakness; no flat feet; no limited function of standing or walking; has left...