Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-01490
Original file (PD-2014-01490.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-01490
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150407
SEPARATION DATE: 20091226


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Aircraft Loadmaster Journeyman) medically separated for chronic right ankle pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards. He was issued a duty and mobility restriction and referred for a Medical Evaluation Board (MEB). The “chronic right ankle pain due to post-traumatic osteoarthritis” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB (IPEB) adjudicated “chronic right ankle pain…” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI appealed to the Formal PEB (FPEB), which affirmed the PEB finding and rating but changed the VASRD code from 5003 to 5271 and was medically separated.


CI CONTENTION: “I believe that an increase in the benefit is appropriate because since being medically separated from the Air Force on 12/26/09 my alinements [sic] that caused my medical separation have worsened. The major problem I had was with my right ankle. During the time in the service I received two surgeries in attempts to repair this ankle, but all were unsuccessful resulting in a final suggestion by the Base Doctors that I have ankled [sic] fused. At the time being a 29 year old father of three I choose to live with the pain, which becomes extreme at times, rather than have a surgery done on my ankle that would exponentially limit my range of motion more than it already was at that point. Over the past 4 and half years since separating my ankle pain has limited my ability to participate in everyday activities such as walking, exercising, driving, even playing with my children, and many more activities. I am experiencing pain in my back, knees, neck, and shoulders due to manner in which my body is trying to compensate for the right ankle pain. Just in the past two years I have had to get pain medication for my back, neck, and shoulder due in largely to my inability to use my right ankle normally. I am consistently trying to improve the condition of my right ankle through medications offered through the VA and over-the-counter along with attempts at physical therapy, which all I have been unsuccessful. The physical therapy I participated in during the service and within the past year did nothing but aggravate my ankle and cause more pain. In addition to my ankle pain, I am still, experiencing hearing issues, headaches, and acid reflux/heartburn, which developed from my time in the service. I was expecting those later aliments to decrease if not disappear altogether after being out of the service for an extended period of time, but that has not happen and in some instances, especially the hearing, they have gotten worse. With all of these problems continuing it has been very difficult for me to dealing with my anxiety, insomnia, and depression. Being a father is something I am very proud of and consider a honor, but nothing pains me more when I have to tell my children that I can't do what most people call normal activities (play football with my son in the back yard, walk the dog with my daughters, play their favorite game 'chase', and so on). I feel like I am letting them down if I don't do these things, so sometimes I try and end up paying for it later with intense pain. It only makes sense that if I was rated at 40% in 12/09 and my aliments [sic] have gotten worse.”


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 20091026
 VA* - (~10 Days Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Ankle Pain due to Post-Traumatic Osteoarthritis 5271 10% Right Ankle Sprain and Microfracture With Surgical Repair 5271 20% 20091216
Scars Right Ankle 5271-7804 0% 20091216
Other x 0 (Not In Scope)
 Other x 12
RATING: 10%
 RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 20 1003 08 (most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Chronic Right Ankle Pain due to Post-Traumatic Osteoarthritis Condition. The narrative summary noted persistent right ankle pain and recurrent sprains following an injury in 2005. Magnetic resonance imaging documented post-traumatic arthritis and conservative management did not return the ankle to full function. The CI underwent arthroscopic surgery and microfracture (for bony resurfacing) in September 2007 and following multiple Synvisc injections, had a second surgery in March 2008. Physical therapy (PT) and rehabilitation were not effective. Further surgery of an ankle fusion was declined.

At the MEB exam, (approximately 9 months prior to separation) the CI reported pain in the right ankle with walking, weight bearing, or dorsiflexion. The MEB physical exam noted decreased range-of-motion (ROM) of the ankle and referenced the PT ROMs charted below. There was mild contracture of the gastrocnemius (shortened calf muscle) with no neurosensory deficits noted. The PT evaluation also documented a mild antalgic gait with stiffness and pain on motion. A clinical treatment note, dated 5 August 2009 (approximately 4 months prior to separation), was referenced by the FPEB and made an assessment of “moderate” limitation of motion, without measured ROMs.

At the VA Compensation and Pension exam, performed 10 days prior to separation, the CI reported weakness, stiffness, swelling, giving way, lack of endurance, locking, fatigability, tenderness, effusion, and intense pain. He had flares of pain up to 10/10 multiple times a day with activities and was taking anti-inflammatory and narcotic medication. He did not use an assistive device and gait was normal. There was no tenderness, instability, weakness or neurovascular deficit noted. Ankle movement was abnormal (limited as charted below), no pain on motion was documented and “the joint function is not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.” The surgical scars were irregular, superficial, and not painful on examination.

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

Right Ankle ROM
(Degrees)
 PT ~9 Mo. Pre-Sep VA C&P ~10 Days Pre-Sep
Dorsiflexion (20 Normal)
 5,5,7 5
Plantar Flexion (45)
 30,32,35 30
Comment
 Antalgic gait, with pain (passive w/in 2 degrees of active ROM Gait normal
§4.71a Rating
 20% (FPEB 10%) 20% (VA 20%)

The Board directed its attention to its rating recommendation based on the above evidence. The key rating criteria in this case is if the CI’s limited right ankle ROMs were “marked” (20% under disability code 5271) or “moderate” (10% under 5271, or other arthritis codes). The Service exam and record supported painful motion, an antalgic gait and gastrocnemius contracture. The clinic note referenced by the FPEB did not provide any ROM measurements. In conjunction with the 5-degree limitation of dorsiflexion and limited plantar flexion, the Board considered that the CI’s disability picture more nearly approximated the VA disability picture for “marked” limitation. Although there was no antalgic gait or painful motion noted at the VA exam (which was closest to separation), there were additional symptoms described including flares and weakness with a similar limitation of motion of the ankle. There was no muscle or nerve injury, and painful motion is included in the 5271 limited motion coding. The ankle scars were not tender, were not noted as interfering with duty performance and did not require military footgear restriction. The Board concluded, therefore, that the scars could not be recommended for additional disability rating. There was no ankylosis of the ankle (frozen joint) and insufficient evidence that the CI’s ankle disability approached equivalency to actual loss of use of the foot for any rating higher than 20%.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), §4.7 (higher of two evaluations), and §4.40 (functional loss); the Board recommends a disability rating of 20% 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, 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 his prior medical separation:

CONDITION
 VASRD CODE RATING
Chronic Right Ankle Pain due to Post-Traumatic Osteoarthritis 5271 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140328, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record






XXXXXXXXXXXXXXXXXXXX
 President
Physical Disability Board of Review


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



Dear XXXXXXXXXXXXXXXXXXXX :

 Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01490 .
         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,





XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
1. Directive
2. Record of Proceedings

cc:
SAF/MRBR

Similar Decisions

  • AF | PDBR | CY2012 | PD2012-00697

    Original file (PD2012-00697.pdf) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW Code 5271 Rating 20% NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200697 SEPARATION DATE: 20031130 BOARD DATE: 20130111 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard SPC/E‐4 (31K10/Combat Signaler), medically separated for “chronic right ankle pain with loss of subtalar joint motion secondary to fracture of the talus (26 Jul 02),...

  • AF | PDBR | CY2013 | PD-2013-02698

    Original file (PD-2013-02698.rtf) Auto-classification: Denied

    No other conditionwas submitted by the MEB.The Informal PEB adjudicated “left knee pain due to degenerative joint disease [DJD]” and “right ankle pain due to degenerative joint disease”as unfitting, rated 10% and 10%, citing application of the DODI and Veterans Affairs Schedule for Rating Disabilities (VASRD). Post-Separation) ConditionCodeRatingConditionCodeRatingExam Left Knee Pain due to DJD5009-500310%Left Knee Residuals, S/P ACL … 5003-526010%20090831Right Ankle Pain due to...

  • AF | PDBR | CY2012 | PD2012-00038

    Original file (PD2012-00038.docx) Auto-classification: Denied

    The PEB adjudicated the chronic right ankle pain status post talar fracture condition as unfitting, rated 10%, with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. ConditionCodeRatingConditionCodeRatingExam Chronic Right Ankle Pain S/P Talar Fracture5099-500310%Chronic Right Ankle Pain and Limited Motion S/P Talus Fracture5273-527110%*STR↓No Additional MEB/PEB Entries↓0% x 0/Not Service Connected x 0 Combined: 10%Combined: 10% *Failed to report to VA Exam...

  • AF | PDBR | CY2012 | PD2012-00046

    Original file (PD2012-00046.docx) Auto-classification: Denied

    Chronic right ankle and foot pain and lower back pain (LBP) were forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. Right Ankle/Foot Condition . Service Treatment Record

  • AF | PDBR | CY2012 | PD2012 01718

    Original file (PD2012 01718.rtf) Auto-classification: Denied

    The Board determined that the most appropriate code for the CI’s right ankle condition was 5271, since there was some limitation of ROM.Based on the evidence in the treatment record, and IAW VASRD §4.71a, the Board determined that the CI’s ankle surgery had left his right ankle in good weight-bearing position. RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: I have carefully reviewed the...

  • AF | PDBR | CY2012 | PD-2012-00144

    Original file (PD-2012-00144.rtf) Auto-classification: Denied

    Left ankle osteoarthritis, characterized as not meeting retention standards, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.The MEB also identified and forwarded a near-sighted conditionas meeting retention standards.The Informal PEB adjudicated “left ankle pain”as unfitting, rated 10%,citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Post-Separation)ConditionCodeRatingConditionCodeRatingExam Left Ankle Pain500310%Degenerative...

  • AF | PDBR | CY2014 | PD-2014-00517

    Original file (PD-2014-00517.rtf) Auto-classification: Approved

    invalid font number 31502 IPEB – Dated 20060915VA* - (~4 days Pre-Separation) ConditionCodeRatingConditionCodeRatingExam Chronic Left Ankle Pain…5099-50030%S/P Left Ankle Arthroscopy Debridement…5271-501010%20061012Scar, S/P Left Ankle Arthroscopy Debridement…780410%20061012Other MEB/PEB Conditions x 0 (Not In Scope)Other x 8 RATING: 0%COMBINED RATING: 50% *Derived from VA Rating Decision (VARD) dated 20061108 (most proximate to date of separation (DOS)). Left Ankle Condition . The VA...

  • AF | PDBR | CY2012 | PD2012-00345

    Original file (PD2012-00345.pdf) Auto-classification: Denied

    The Physical Evaluation Board (PEB) adjudicated the chronic ankle instability condition as unfitting, rated 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The VA’s 20% rating under the 5271 code (ankle, limited motion of) was based on a “severe” ROM impairment as noted in the STR. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record President Physical Disability Board of Review 3 PD12-00345 MINORITY OPINION: The...

  • AF | PDBR | CY2013 | PD-2013-02629

    Original file (PD-2013-02629.rtf) Auto-classification: Approved

    Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Bilateral Ankle Pain5099-500310%Stress Reaction Right Ankle52710%*20040804Stress Reaction Left Ankle52720%*20040804Other x0 (Not in Scope)Other x2 Rating: 10%Combined: 0%Derived from VA Rating Decision (VARD) dated 20050114 (most proximate 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...

  • AF | PDBR | CY2014 | PD 2014 00304

    Original file (PD 2014 00304.rtf) Auto-classification: Approved

    The commander’s statement to the PEB (2 months prior to the CI’s separation),noted that the MEB would evaluate the CI’s ability to perform his duty based on limitations imposed by his permanent physicalprofile for bilateral ankle instability. The left knee condition was Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with...