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AF | PDBR | CY2013 | PD-2013-02738
Original file (PD-2013-02738.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-02738
BRANCH OF SERVICE: Army  BOARD DATE: 20150129
SEPARATION DATE: 20070108


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Military Police) medically separated for chronic right ankle pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty but he was authorized to perform two alternate aerobic physical fitness test events. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The condition characterized as “chronic right ankle pain; traumatic at STJ (subtalar joint)” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated chronic right ankle pain as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “I was given inserts for my shoes and a cane to help me walk and during the examination I had trouble walking even though my disability rating states “you do not have any limitations with standing or walking.” In 2004 I was evaluated by a doctor and told I had 9 years left walking on my foot. I can barely walk for longer than short periods of time. I had to change jobs and my career because I can’t meet the physical demands of the job that requires running and walking/standing. I was an MP and my career field was in secret/law enforcement.”


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 20060928
 VA* - (~9 Mos. Pre-Separation) -
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Ankle Pain… 5010 0% Residuals of Right Ankle Fracture with Talonavicular
Joint Osteoarthritis, Right Foot		 5271 20% 20061031
Other x 0 (Not In Scope)
 Other x 8
RATING: 0%
 RATING: 20%
* Derived from VA Rating Decision (VA RD ) dated 20 070127 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY:

Chronic Right Ankle Pain Condition. The narrative summary (NARSUM) noted the CI sustained a twisting injury to his right ankle in December 2000... This injury was treated as a “sprain” and a painful ankle condition developed. By report, routine X-rays and magnetic resonance imaging of the ankle in October 2002 were normal. The condition worsened during deployments to Japan and Iraq. On 1 August 2005, a range-of-motion (ROM) evaluation was performed by physical therapy (PT). No pain was noted on motion, but ankle pain was reported with weight bearing. The results of this exam are summarized below. Routine X-rays of the ankle, obtained on 27 March 2006, revealed marked degenerative changes with “spurring” of the top of the ankle joint (dorsal talo-navicular joint). A CT scan of the right ankle, obtained on 29 March 2006, revealed a possible fibro-cartilaginous talo-navicular coalition (scar between two bones, but no bony coalition (abnormal fixed connection between the bones) or obvious fractures. An old small free bone fragment was documented in the joint. On a podiatry evaluation of the ankle on 8 June 2006, tenderness to palpation with limited ROM of the ankle with extensive grinding of the upper foot was reported. The examiner opined the condition was not operable. On 10 July 2006, the CI successfully passed the Army PT test, completing a 2.5 mile walk in 29 minutes. At the MEB/NARSUM evaluation on 1 August 2006, 5 months prior to separation, the CI’s gait was reported as normal. No swelling or tenderness to palpation of the foot was present. Pain and stiffness was present on motion. Ankle strength was reported as “good” and neurologic exam was normal. At the VA Compensation and Pension (C&P) exam performed 3 months prior to separation, the CI reported pain usually at the top of his foot. The CI reported being able to do all activities of daily living, to drive his car, climb steps and push a lawn mower. On physical examination the gait was normal without assistive device. No swelling or edema was present. The right ankle was described as “weaker than the left as determined by failure to stand steadily on the right foot with the left elevated.” Later in the exam, the examiner later in the exam reported motor and sensory in the lower extremities to be “normal.” ROM findings on this exam are summarized in the chart below. Routine X-ray of the right foot reported an old healed fracture of the ankle bone (Talus) and arthritic changes of the joint.

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below:


Right Ankle ROM
(Degrees)		 PT ~ 17 Mo. Pre-Sep
(20050801
 VA C&P ~ 3 Mo. Pre-Sep
(20061031)
Dorsiflexion (20 Normal) 20 no pain 5
Plantar Flexion (45) 3 0 10
Comment Gait normal; Pain on weight bearing. Gait ’ motor strength, sensation reflexes normal.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition 0%, code 5010 (arthritis traumatic) citing that only one joint was involved. Code 5010 is rated under code 5003 (arthritis degenerative).
Under this code, a rating of 10% requires involvement of two or more major or minor joints. The VA rated the condition 20% Code 5271 (ankle, limitation of motion/marked). A 10% rating under this code requires the condition to be “moderate.” A 20% rating requires the condition to be “marked.” No higher rating is achievable under this code. The Board unanimously agreed that the record supported a 10% rating for painful motion of the ankle IAW §4.59. The Board considered a rating under ROM criteria, code 5721. The Board noted the marked decreases in both dorsi-flexion and plantar flexion on the C&P exam. The Board agreed that these severe findings were internally inconsistent with the cotaneously reported normal gait. The Board agreed that the record in evidence supported the CI to have a “moderate” decrease in foot motion, and to support a 10% under this code. The Board agreed the overall ankle condition was “moderate” given the mild functional impairment discussed above, and could be rated no higher than 10% under codes 5284 (foot injury) and 5283 (tarsal bones, malunion). A higher rating of rating under these codes requires the condition to be “moderately severe,” which is not supported by the record in evidence. The Board found no other appropriate codes for consideration and no pathway to a rating higher than 10% for the ankle condition. 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 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 right ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5284 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:

CONDITION VASRD CODE RATING
Chronic Ankle Pain 5284 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131216, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record



XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20150008489 (PD201302738)


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     XXXXXXXXXXXXXXXXXX
                  Deputy Assistant Secretary of the Army
                  (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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