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AF | PDBR | CY2013 | PD-2013-02629
Original file (PD-2013-02629.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX     CASE: PD -20 1 3 - 0 2629
BRANCH OF SERVICE: Army   BOARD DATE: 2014 1121
Separation Date: 20050101


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (15D/Aircraft Powertrain Repairer) medically separated for bilateral ankles. The bilateral ankle condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS). Her profile allowed for an alternate aerobic event to satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). Bilateral ankle pain was forwarded by the MEB to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic bilateral ankle pain” as a condition existing prior to service without permanent service aggravation. The CI appealed to the Formal PEB (FPEB) who found the bilateral ankle condition unfitting, as a single combined condition, rated 10%, referencing application of the US Army Physical Disability Agency (USAPDA) pain policy and was medically separated.


CI CONTENTION : “The conditions that rendered the member unfit are getting so bad she is unable to work at all.”


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 bilateral ankles is addressed below; and, 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.

The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

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RATING COMPARISON :
Service FPEB – Dated 20041119
 VA - (5 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Bilateral Ankle Pain 5099-5003 10% Stress Reaction Right Ankle 5271 0%* 20040804
Stress Reaction Left Ankle 5272 0%* 20040804
Other x 0 (Not in Scope)
 Other x 2
Rating: 10%
 Combined: 0%
Derived from VA Rating Decision (VARD) dated 20050114 (most proxi mate to date of separation )
VARD dated 20060913 increased rating to 10% for each ankle effective 20060623


ANALYSIS SUMMARY : The FPEB diagnosed the combined the bilateral ankle pain as a single unfitting condition as indicated on DA Form 3947. This approach is countenanced by AR 635-40 (B.24f.), but IAW DoDI 6040.44 the Board must apply only VASRD guidance to its recommendation. The Board must therefore apply separate codes and ratings in its recommendations if compensable ratings for each joint are achieved IAW VASRD §4.71a. If the Board judges that two or more separate ratings are warranted in such cases, however, it must satisfy the requirement that each “unbundled” condition was unfitting in and of itself.

Bilateral Ankle Pain Condition . The CI developed chronic ankle pain during basic training in March 2002 and further training was delayed while an MEB evaluation occurred. The CI was evaluated for tenderness of the right and left tibial shaft. The m edical provider noted foot pain with activity and physical exam findings of tenderness and weakness in both ankles. A right ankle and foot X -ray images w ere normal. The CI was evaluated by p hysical t herapy (PT) for chronic bilateral ankle pain. A b one s can demonstrated minimal stress reaction in the left tibia. The p odiatrist noted right ankle pain and diagnosed recalcitrant ankle pain. The p ain m anagement specialist documented increased bilateral ankle pain with intermittent swelling and bruising and increased cold sensation. There were physical findings of bilateral ankle pain with dorsiflexion and tenderness to palpation ( TTP ) over both medial malleoli and dorsal aspect of feet with slight decrease in right foot eversion. The o rthopedist noted persistent bilateral ankle pain and physical exam findings of moderate TTP in the medial tibia and pain with increased bilateral percussion.

The first c ommander’s s tatement documented a n L3 Profile for ankle pain which interfered with her ability to perform within her MOS. The second c ommander’s s tatement documented a L2 Profile for ankle pain and t he CI could run at her own pace. Throughout 2003, the CI continued treatment with PT and o rthopedics for bilateral ankle pain. After undergoing extensive testing including X -rays , magnetic resonance imaging ( MRI ) and physiotherapy, there was no definitive diagnosis . The CI contested the lack of diagnosis and the MEB was stopped due to a reduction in profile from P3 to P2. Based on these circumstances, the CI was able to complete the physical requirements for training and achieved her MOS. At her first duty station, t he CI was seen by p rimary c are for bilateral 10/10 ankle pain , for duration of 2 weeks. A b one s can showed mild diffuse stress reactions in the left great er than the right ankle joint. The CI was given an L3 Profile for left and right ankle pain.

The third c ommander’s s tatement documented that the CI was still experiencing pain in both ankles. The first MEB n arrative s ummary (NARSUM) exam completed ( approximately 10 months prior to separation ) documented that the CI had chronic bilateral ankle pain . The examiner opined that the prognosis for the CI’s return to constructive active duty was considered poor. The MEB NARSUM physical exam findings are summarized in the chart below . Plain film X -ray s of both feet were normal. A bilateral ankle MRI showed a normal right ankle and a left ankle which showed evidence of a prior sprain . An e lectromyogram demonstrated radicular syndrome S1.
The VA Compensation and Pension (C&P) exam approximately 5 months prior to separation was missing and data was taken from the VARD on 14 January 2005 which cited the C&P exam. The VA C&P physical exam findings documented by the VARD were summarized in the chart below . The MEB addendum performed approx imately 2 months prior to separation , noted bilateral ankle pain and that the CI had excessive joint laxity. The physical exam findings ( done by PT ) are summarized in the following chart.

There were two goniometric range - of - motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; a s summarized in the chart below:

Ankle ROM (Degrees) 1 st MEB ~9.5 Mos. Pre-Sep VA C&P 5. Mos. Pre-Sep MEB Addendum ~2.5 Mos. Pre-Sep
Left Right Left Right Left Right
Dorsiflexion (20 Normal) 5-10 15 FULL ROM 6 8
Plantar Flexion (45) 20 25 58 58
Inversion 35-45 - - 23 35
Eversion 15-25 - - 2 1 22
Comment Pos. painful motion; Normal gait Pos. TTP & laxity; No painful motion Pos. TTP ; Normal gait
§4.71a Rating 10% 10% 0% 0% 10% 10%
PEB - FPEB 10%
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The Board directed attention to its rating recommendation based on the above evidence. The PEB coded the bilateral ankle pain condition as 5099 analogous to 5003 a rthritis, degenerative (hypertrophic or osteoarthritis ) and rated at 10% with application of the USAPDA pain policy . The VA coded the stress reaction right ankle condition as 5271 ( limited motion of the ankle ) and rated at 0% and stress reaction left ankle condition as 5272 ( ankylosis of the s ubastragalar or tarsal joint ) , also rated at 0%.

The Board first considered whether the left and right ankle pain conditions, having been de-coupled from the combined PEB adjudication, remained independently unfitting as established above. The CI was issued a permanent profile related to the bilateral ankle pain condition in January 2004 with restrictions of no running, no standing more than 2 hours and no ruck sack or walking on uneven ground. Either lower extremity alone would have resulted in the same profile. The three commander’s statements documented that the CI had ongoing bilateral ankle pain which interfered with her ability to perform her MOS duties. All Board members agreed that the left and right ankle pain, each as an isolated condition, would have rendered the CI incapable of continued service within her MOS and each accordingly merits a separate rating. The MEB addendum exam was 3 months prior to separation and was the most probative exam for the Board to base its recommendation. That exam documented limitation of dorsiflexion in both ankles which justifies application of code 5271 (limitation of ankle motion). Board deliberations considered the moderate 10% rating verses the marked 20% rating. Board members agreed that the CI’s normal gait and normal dorsiflexion were more consistent with a moderate, 10% rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 Reasonable doubt, all Board members recommend a separate disability rating of 10% coded 5271, IAW VASRD §4.71a, for each ankle.


 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 ( AR 635-40) for rating the bilateral ankle pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the b ilateral a nkle p ain condition, the Board unanimously recommends that each joint be separately adjudicated as follows: an unfitting right ankle pain condition coded 5271 and rated 10%, and an unfitting left ankle pain condition , coded 5271 and rated 10%, both 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 h er prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Right Ankle Pain 5271 1 0%
Left Ankle Pain 5271 10%
COMBINED (w/ BLF) 2 0%
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The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 131114 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX , AR20150007067 (PD201302629)


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                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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