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AF | PDBR | CY2014 | PD-2014-01516
Original file (PD-2014-01516.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-01516
BRANCH OF SERVICE: Army  BOARD DATE: 20150311
SEPARATION DATE: 20080527


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Military Intelligence) medically separated for a right ankle condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The right ankle condition, characterized as “post-traumatic subtalar degenerative joint disease, decreased talar ROM , and right ankle pain s/p ORIF failure and removal,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also forwarded “right knee medial meniscal tear s/p arthroscopic medial menisectomy” as meeting retention standards. The Informal PEB combined the three right ankle conditions, and adjudicated “right ankle, limited motion due to posttraumatic arthritis” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The PEB found the right knee condition not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “I believe that the overall 30% rating rendered because of my injuries are an extremely low rating. I currently live in constant pain in the affected areas (right foot & knee) that have limited my normal daily functions. I cannot stand for a prolonged amount of time and if l walk for an extended amount of time my pain level goes up and the effects last days after. I have missed the opportunity to play normal sports with my children due to the pain I suffer from. I have also spoken to other Veterans and their rating is higher than mine and I do have a visible limp when walking. Because of my injury I lost the opportunity to retire from the military and take advantage of the great benefits that come with retirement. I respectfully request my rating be revised and upgraded to a higher rating.”


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 :

Army IPEB – Dated 20080228
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Ankle Condition 5010-5271 20% Right Ankle Condition 5271 20% 20081125
Right Knee Condition Not Unfitting Right Knee Condition 5260 10% 20081125
Other x 0 (Not In Scope)
 Other x 0
Combined: 20%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 20090109 ( most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Right Ankle Condition. In May 2007, this CI suffered a fracture/dislocation of the right ankle. He underwent open reduction and internal fixation (ORIF). After surgery, he continued to have significant pain in the right ankle. In October 2007, he was seen by Orthopedics, and was diagnosed with post-traumatic subtalar degenerative joint disease. The ORIF hardware was surgically removed from the right ankle at that time. Over the months that followed, he continued to have problems with that ankle. Due to the chronic, persistent nature of his right ankle pain, an MEB was initiated. The MEB physical examination (PE) was performed on 12 February 2008, 3 months prior to separation. At that exam, the CI was using a cane for ambulation and he walked with a stiff right leg. He used the wall for balance and support during the exam. PE of the right ankle showed some swelling and tenderness to palpation just behind the lateral malleolus. Range-of-motion (ROM) was measured, and is summarized in the chart below.

At the VA Compensation and Pension (C&P) exam on 25 November 2008, 6 months after separation the CI was using a cane and his gait was antalgic. PE of the right ankle showed ankle alignment in the neutral position of 90 degrees (normal). There was no laxity, grinding, tenderness, or evidence of painful motion. Muscle strength was 5/5 (normal). With repetition, there were no additional limitations due to pain, fatigue, weakness, incoordination, or lack of endurance. The ROM evaluations which the Board weighed in its deliberation are summarized in the chart below.

Right Ankle ROM
(Degrees)
 MEB ~ 3 mos . Pre-Sep
VA C&P ~ 6 mos . Post-Sep
Dorsiflexion (20 Normal)
 10 15
Plantar Flexion (45)
 10 10

The Board directed attention to its rating recommendation based on the above evidence. The Army PEB used diagnostic code 5010-5271, and assigned a disability rating of 20% for marked loss of motion. After due deliberation, the Board determined that the CI’s limitation of ankle motion was best described as “marked.” Therefore, a rating of 20% was appropriate for the right ankle condition. There was no path to a higher rating, because there was no ankylosis. A higher rating of 30% would require ankylosis of the ankle (“frozen” joint, with no motion). Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the right ankle condition.

Right Knee Condition. The CI also suffered an injury to his right knee. Magnetic resonance imaging showed a horizontal cleavage tear in the posterior horn of the medical meniscus. On 29 October 2007, he underwent arthroscopic surgery on the right knee. At his MEB physical exam, he reported that his right knee was improving, and it did not interfere with his MOS duties. Right knee ROM was 0-140 degrees (normal).

At the 25 November 2008 C&P exam, 6 months after separation, there was no tenderness, effusion, crepitus, laxity, or muscle atrophy. McMurray and drawer testing were negative. Right knee ROM was 0-125 degrees. With repetitive motion, there were no additional limitations due to pain, fatigue, weakness, incoordination, or lack of endurance.

The Army PEB found the right knee condition not unfitting, and therefore not ratable. The Board’s main charge with respect to this condition is to assess the appropriateness of the PEB’s fitness adjudication. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. This condition was reviewed by the action officer and considered by the Board. The Board deliberated at length regarding whether or not the knee condition was unfitting. Although the commander implicated the right knee referencing his duty performance, the right knee condition was not profiled, and it was judged by the MEB to meet retention standards IAW AR 40-501. The Board also noted that during the MEB examination, the CI indicated that his right knee was improving, and it did not interfere with his MOS duties. After due deliberation, and consideration of the preponderance of the evidence, the Board found insufficient cause to recommend a change in the PEB fitness determination for the right knee.


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. In the matter of the right knee condition, the Board unanimously recommends no change from the PEB determination as not unfitting. 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 20140327, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX , AR20150013465 (PD201401516)

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 and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

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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