Diagnoses

[jim1960]

Well I am having an interesting time with my PEBLO and the Diagnoses on my ankle. I have ROM of less than 10 degrees of dorsiflexion due to torn Achilles tendon and surgery to try to correct problem.
AR 40-501 par 3-13
d. Joint ranges of motion (ROM). ROM that does not equal or exceed the measurements listed below. Measurements should be made with a goniometer (a bubble goniometer/inclinometer is also acceptable) and conform to the methodsillustrated and described in the VASRD.
(1) Hip—flexion to 90 degrees or extension to 0 degree.
(2) Knee—flexion to 90 degrees or extension to 15 degrees.
(3) Ankle—dorsiflexion to 10 degrees or planter flexion to 10 degrees.
The Doc at the MEB says Rom is not a Diagnoses so he is using AR 40-501 par 3-14
m. Tendon transplant with fair or poor restoration of function with weakness that seriously interferes with the function of the affected part.
I keep telling them I did not have a transplant I had a transfer, and my surgeon tells me they are different.

The PEBLO tells me that the PEB will rate for the poor restoration of function and the ROM, but I thought they could not rate you for the same thing twice. I am also concerned that I remember reading in the VASRD that a Tendon transplant with fair or poor restoration of function was a 20% disability but ROM of less than 10% is a 30%.

I also do not agree with the ROM done at the MEB so I am submitting ROM from my civilian therapist.

This is getting very old.

[Jason]

jim1960,

Part of the problem is that they use different terms for the disqualifying conditions (AR 40-501) and in the VASRD. But I don't know why they are getting caught up on the "ROM is not a diagnosis." It does not have to be, the criteria for 3-13, d., appears to clearly be met. However, in this case, I don't know that it will impact your rating under the VASRD.

You are correct that they won't rate for the same issue in the same body part. That would be pyramiding.

From the info you provided, I think you are probably looking at rating under:

5271 Ankle, limited motion of:

Marked............................................ ..................................... 20
Moderate .................................................. ............................ 10

Or under:

5310 Group X. Function: Movements of forefoot and toes; propulsion thrust
in walking. Intrinsic muscles of the foot: Plantar: (1) Flexor digitorum
brevis; (2) abductor hallucis; (3) abductor digiti minimi; (4) quadratus
plantae; (5) lumbricales; (6) flexor hallucis brevis; (7) adductor hallucis;
(8) flexor digiti minimi brevis; (9) dorsal and plantar interossei. Other
important plantar structures: Plantar aponeurosis, long plantar and
calcaneonavicular ligament, tendons of posterior tibial, peroneus longus,
and long flexors of great and little toes.

Severe .................................................. .................................................. . 30

Moderately Severe .................................................. ................................. 20
Moderate .................................................. ............................................... 10
Slight .................................................. .................................................. . 0

I think you were talking about the ratings for ankylosis, which you can think of as a frozen joint. If you can move the joint, you won't get rated under DC 5270. I would, however, get an accurate ROM, because it will be an argument for how severe the limitation is.

Hang in there!

[jim1960]

Jason,

This is what I have based my thoughts on.

Ankylosis, or Anchylosis (from Greek αγκυλος, bent, crooked) is a stiffness of a joint, the result of injury or disease. The rigidity may be complete or partial and may be due to inflammation of the tendinous or muscular structures outside the joint or of the tissues of the joint itself. When the structures outside the joint are affected, the term "false" ankylosis has been used in contradistinction to "true" ankylosis, in which the disease is within the joint.

If this is correct then this is what I think it should be rated under
5270 Ankle, ankylosis of:

In plantar flexion at more than 40º, or in dorsiflexion at more
than 10° or with abduction, adduction, inversion or eversion
deformity......................................... .................................................. ............. 40
In plantar flexion, between 30º and 40º, or in dorsiflexion,
between 0º and 10º............................................... ................30
In plantar flexion, less than 30º............................................... ....................... 20

It is sad to think that I can’t walk a normal gait have to use a cane and may be rated under 30%

[Jason]

Jim1960,

For VA purposes (and thus for the PEB) ankylosis is defined as:
""Ankylosis" is immobility and consolidation of a joint due to disease, injury, or surgical procedure, DORLAND'S at 91.)" Shipwash v. Brown, 8 Vet. App. 218, 221 (Vet. App. 1995).

If there is very slight movement, there may be some room to argue this, but if you can move it and they have not mentioned ankylosis in your treatment notes, then you will not get rated for ankylosis.

However, I don't mean to suggest that you cannot get to 30% if your mobility is greatly impacted. It would really take a full analysis of your condition and functional limitation, but there may be arguments for the loss of functional limitation being equivalent to loss of the foot, for example. It is possible to argue for an extra-schedular rating, though I have seen a PEB do this only once and it was overturned by the APDA. If it comes down to this argument, if the facts are strong, you will likely not get rated by the PEB. But it is possible you may win on appeal (especially if they do not analyze or respond to the argument in their rating decision).

The VASRD on its own is pretty stingy on ankle ratings, in my opinion. I wish I could tell you based on an ankle it will be easy to get to 30%. But it is more likely to be an uphill battle.

[jim1960]

Jason,

Thanks for the information. I do have movement down just nothing from
-5 (of 90 degree) up. I do have a very limited gait and this was noted at the MEB. I agree that the VASRD does not do much for ankle problems. I would hope that the word "Severe" would apply to my ankle as normally you have over 10 degrees up movement. I guess I shuld have known that nothing is easy and that even after 28 years in the military i would have to fight to the bitter end.