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AF | PDBR | CY2014 | PD 2014 00319
Original file (PD 2014 00319.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX      CASE: PD -20 1 4 - 00 319
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20141114
SEPARATION DATE: 20011217


SUMMARY OF CASE : T he available evidence of record reflects that this covered individual (CI) was an active duty A1C /E-5 ( 2A333C / F-16 Crew Chief ) medically separated for right ankle pain . The condition could not be adequately rehabilitated to meet the requirements of his Air Force Specialty (AFS) or physical fitness standards . He was issued a temporary L4 profile and referred for a Medical Evaluation Board (MEB). The right ankle condition , characterized as “ right ankle lateral degenerative [ sic ] joint disease ” and “ status post lateral ligament reconstruction with superficial peroneal nerve injury ”, was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123 . No other conditions were submitted by the MEB. The PEB adjudicated the right ankle condition as unfitting, rated at 10%, referencing the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Injury more severe than awarded, VA fused Right ankle.”


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 ankle condition 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 his service-connected condition continues to burden him’ 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, operating under a different set of laws. 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.


 RATING COMPARISON :

Service IPEB – Dated 20011102
 VA - (9 Yrs., 11 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Ankle Pain Secondary to Degenerative Disc Disease. 5003 10% Right Ankle Injury, Post Operative Lateral Reconstruction w ith Degenerative Joint Disease and Mild Ligament Laxity Laterally (Claimed as Arthritis of the Right Ankle) 5010-5271 10% 20101108
Rating: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 20 110307 .
ANALYSIS SUMMARY:

Right Ankle Condition. The CI sustained an inversion injury to his right ankle in November 2000. Initial routine X-rays images were normal. Despite treatment, a painful ankle condition developed. A magnetic resonance imaging (MRI) of the ankle obtained on 5 April 2001 revealed no bony fractures but a small defect in inner foot bone (Talus) thought to be an old injury site (osteochondritis). Tendons and ligaments were intact. Routine X-rays images take with stress movement of the ankle revealed instability of the outer right (lateral) ankle joint. This was surgically repaired on 11 June 2001, which during procedure a small osteophyte, (bone spur) and small defect in the foot bone, defined on the MRI, were encountered and debrided. The injured lateral ligaments were repaired with small anchor screws and suture. Subsequent X-ray images revealed that the surgical site heal without residual fracture, arthritis, nonunion or screw difficulty. Postoperatively the CI had continuous ankle pain and developed a new symptom of numbness over the outside top of the right foot.

At post-operative evaluation performed on 3 August 2001, the CI’s range-of-motion (ROM) of the ankle was “full” with painful motion but no instability. Numbness of the top (dorsum) of the foot was present. On evaluation 28 August 2001, pain on extreme upper flexion without instability was reported. Decreased sensation on the top of the foot was again noted.

At the MEB NARSUM examination performed on 28 September 2001 (3 months prior to separation), the CI reported continuous ankle pain with weight bearing. The MEB physical exam noted the right hip and knee to be normal. Pain without instability was present on motion of the right ankle. Goniometric measured ROM of the ankle, quoted from a physical therapy evaluation dated 18 September 2001 was normal. Motor strength of the ankle and foot was normal. Decreased sensation to light touch and pain was present on the top of the foot.

The VA Compensation and Pension (C&P) exam was performed 9 years and 11 months post separation. The Board agreed this had little probative relevance to the condition at the time of separation.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and the VA, both rated the right ankle condition at 10% but used different codes; the PEB used code 5003, (arthritis) and the VA, code 5271 (ankle, limited motion/moderate) both IAW §4.71a. A higher rating of 20% under this code requires the condition to be “marked”. The Board unanimously agreed that the record supported a 10% rating for painful motion IAW §4.59. The Board agreed the ankle was not compensable under ROM criteria. The Board agreed the ankle condition was “moderate” and could be rated no higher than 10% under analogous codes 5284 (foot injury) and 5283 (tarsal bones, malunion). A higher rating under these codes requires the condition to be “moderately severe”. The Board noted the numbness on the top of the right foot after surgery but agreed that there was no evidence for ratable peripheral nerve impairment in this case, since no motor weakness was present and sensory symptoms had no functional implication and were not unfitting per se. 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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right 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 and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131112, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record







                 
XXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAF/MRB
Dear XXXXXXXXXXXXXX:

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-00319

         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 appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

                                                               Sincerely,






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

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