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AF | PDBR | CY2013 | PD-2013-02585
Original file (PD-2013-02585.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX         CASE: pd-2013-02585
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150408
SEPARATION DATE: 20020715


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Dietary Therapy Apprentice) medically separated for right ankle and foot pain. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards. She was issued an L3 profile and referred for a Medical Evaluation Board (MEB). “Ankle pain” and “chronic bilateral foot pain” were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated “chronic right ankle/foot pain, secondary to subtalar joint coalition excision” as unfitting, rated 10% citing application of Department of Defense guidelines and the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI appealed to the Formal PEB (FPEB), which affirmed the IPEB findings and rating. The CI further appealed to the USAF Personnel Council which upheld the FPEB adjudication. She made no further appeals and was medically separated.


CI CONTENTION: “The Surgery done on my ankle made it worst [sic] and it gave me Arthritis, Complex Regional Pain Syndrome, Nerve Damage and I should have been medically retired.”


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 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 :

FPEB – Dated 20020412
 VA* - 3 months Post-Separation
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Ankle/Foot Pain, … 5271 10% Chronic Ankle Arthralgia… 5271 20% 20021007
Scar, Right Ankle 7804 10% 20021007
Other x 0 (Not In Scope)
 Other x 9
RATING: 10%
 COMBINED RATING: 50%
* Derived from VA Rating Decision (VA RD ) dated 200 21219 (most proximate to date of separation ( DOS ) ) .

ANALYSIS SUMMARY:

Chronic Right Ankle/Foot Pain. The CI was first seen for a 2-day history of right foot pain on 8 July 1999 in her third week of basic training. She was treated with duty modifications, but was able to finish basic and technical training with these limitations. On 3 June 2000, she sprained her right ankle after stepping on a rock. She was again treated conservatively with medications, duty modifications, and was non-weight bearing with crutches. Her symptoms persisted and on 23 October 2000 she reported in primary care that both ankles hurt and swelled if she stood on them over 5 hours despite medications and heel lifts. She was treated in physical therapy (PT) without success. A magnetic resonance imaging on 23 October 2001 revealed a talocalcaneal coalition (an abnormal bridging between the ankle bone of the foot and the heel bone). She was evaluated in orthopedics and surgical resection was offered as she had failed conservative management. It was explained to her that the success rate for this procedure was not high, but the CI wanted to remain on active duty and elected to proceed. The operation was on 24 July 2001. Despite rehabilitation in PT, her pain continued and she was not able to meet her duty requirements. The CI was issued an L4 profile on 17 September 2001 which limited activities, but did not restrict her from the wear of military boots or shoes. On 9 November 2001, the commander wrote that cross training into an administrative position would be an option as she was an “eager worker.” The narrative summary was dated 4 December 2001 and noted that the CI had persistent cramping, swelling, and burning in her right ankle which limited ambulation. Podiatry provided an addendum on 7 February 2002 which noted that she was now 6 months after surgery and had not benefited from it (possibly worsened). She did not benefit from medications or orthotics. She was noted to have swelling and reduced motion of the sub-talar joint (which does not involve dorsiflexion or plantar flexion). Medical discharge was recommended. An update on 18 March 2002 documented that this was a progressive condition and eventual fusion of the joint was probable. No comment was made regarding the scar. A podiatry evaluation on 28 May 2002 documented a 50% reduction in her pain with a lace up ankle brace and ice massage.

At the VA Compensation and Pension (C&P) examination performed on 7 October 2002, 3 months after separation, the CI reported that she was working at a local auto dealer as a service cashier. She noted minor problems with her ankles in high school and that she had inverted her right ankle. She endorsed swelling and locking with pain after prolonged standing. She could not plant her heel on the ground or walk barefoot. She had pain along the surgical scar which was well healed. Dorsiflexion was limited to 5 degrees (normal is 20) and plantar flexion to 30 degrees (normal is 45). She was unable to plant her right heel fully on the floor; it remained about one inch off the floor. This was documented in the evaluation of her bilateral flat feet. The examiner did not indicate if this was secondary to the ankle, flat feet, or knee problems. X-rays of the feet and ankles were normal.

The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA both used the code 5271 (limited motion of the ankle) for the right ankle and rated it 10% and 20%, respectively. As noted in the summary, the PEB adjudication stood on two separate appeals and reviews. The range-of-motion (ROM) documented by the MEB examiner was for the sub-talar joint rather than plantar or dorsiflexion. The Board found no ROM values for these in the service treatment records proximate to separation. The VA C&P values support a 20% rating for the loss of dorsiflexion. The Board found no route to a higher rating and noted that the 20% rating was retained by the VA on subsequent review. 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 right ankle/foot 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, the Board unanimously recommends a disability rating of 20%, coded 5271 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 her prior medical separation:

CONDITION
 VASRD CODE RATING
Chronic right Ankle/Foot Pain 5271 20%
RATING
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131114, with attachments
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record







XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

invalid font number 31506

SAF/MRB

 1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXX

Dear XXXXXXX:

 Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-02585 .
         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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities. Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force. The office responsible for making the correction will inform you when your records have been changed.

 Sincerely,





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

cc:
SAF/MRBR

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