RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-00414
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20040106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Patriot Missile Operator Maintainer) 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).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “right ankle instability,” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were forwarded for adjudication.  The Informal PEB adjudicated “chronic right ankle pain,” as unfitting, rated 0%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Over the last 10 years my disability has increased in its severity. My chronic pain level has increased from 3-4 ratings to 6-7 ratings and arthritic pain is much more prevalent and consistent than it was at the time of my initial disability rating. This chronic pain has impaired my ability to run and participate in many physical activities.”  His complete submission is at Exhibit A.

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 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 20031205	VA* - (~6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	0%	S/P Right Ankle Sprain Healed	5271	10%	20040705	
Other x 0 (Not In Scope)	Other x 0	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20040825 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Chronic Right Ankle Condition.  According the service treatment records and the MEB narrative summary (NARSUM), the CI sprained his right ankle 21 March 2003.  Ankle X-rays were normal and the CI was treated with an ankle bracing and physical therapy.  After 4 months of therapy the CI continued to have pain with weight bearing activities and was referred for orthopedic evaluation.  Repeat X-rays in July 2003 were normal except for soft tissue swelling and magnetic resonance imaging showed no abnormalities of the bone, ligaments, tendons or joint cartilage.  The CI was placed in a controlled ankle motion (CAM) boot in July 2003 and an orthopedic follow-up 25 August 2003 indicated that the CI reported continued ankle pain and a feeling of instability.  The exam noted tenderness to palpation (TTP) of the ankle with full, but painful range-of-motion (ROM), and a positive test for anterior instability, but stress X-ray views in August 2003 showed comparable motion of both ankles.  An orthopedic follow-up visit 30 September 2003 noted the ankle symptoms and exam were unchanged despite physical therapy and bracing.  Arthroscopic surgery was recommended, but the CI declined.  He was given a permanent profile and an MEB was initiated.

The MEB exam documented on the DD Form 2807, Report of Medical History, and 2808 Report of Medical Examination, dated 6 October 2003, noted an arthroscopic surgery was recommended to repair ankle impingement.  At the MEB narrative summary (NASRSUM) exam 20 October 2003, 3 months before separation, the CI reported right ankle instability and continuous use of a CAM boot.  The examination noted a normal gait without the CAM boot.  There was TTP of the joint lines and a ligament (anterior talofibular ligament) in the area.  There was full, but painful ROM of the ankle.  All tests for instability were negative and sensation and pulses of the foot were normal.

At a VA outpatient podiatry evaluation 1 April 2004, 3 months after separation, the CI reported he was doing well since he stopped use of the CAM walker and started physical therapy, with pain occasionally after running.  The exam noted normal ROM, without swelling, crepitus, or pain with passive ROM.

At the VA Compensation and Pension (C&P) General exam 3 June 2004, 5 months after separation, the CI reported morning stiffness and pain and swelling of the ankle in the evening, without locking or giving way.  He reported that he was using a rigid right ankle splint.  The exam noted a normal gait.  There was TTP of the ankle with full ROM and no swelling.  At the VA C&P Joints exam 5 July 2004, the CI reported constant right ankle pain and a feeling of instability.  The exam noted a normal gait without use of an assistive device, and there was no mention of an ankle brace.  Ankle ROM was dorsiflexion of 10 degrees (normal 20) and plantar flexion of 45 degrees (normal 45).  There was “minimal tenderness” of the ankle and no pain with “forced” ROM.  No joint instability or ligamentous laxity was noted.  Sensation and pulses of the foot were normal.  The CI was able to walk on his heels and toes and do a full squat without difficulty.  Ankle X-rays were normal, without evidence of degenerative joint disease.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition 0%, coded 5099-5003 (Analogous to degenerative arthritis), of a single joint without limitation of motion.  The VA rated the condition 10%, coded 5271 for moderate limitation of ankle motion.  The Board first considered the 5271 rating criteria which are subjective, with 10% for `moderate’ and 20% for `marked’ limitation of ankle motion.  The Board agreed that the evidence supports a 10% rating of the ankle at the time of separation coded 5271 for painful motion IAW VASRD §4.59 (Painful motion) noted at the MEB exam and moderate limited ankle ROM noted at the C&P Joints exam and that the normal gait observed at both these exams was consistent with characterizing the limitation of motion as `moderate’ and not `marked’.  A 10% rating is also supported coded analogous to 5003 or 5024 (Tenosynovitis), of a single joint with limited motion.  The Board next reviewed to see if the evidence supports a rating greater than 10% with any other applicable code.  However, no higher than a 10% rating can be provided for a single joint coded according to 5003 rating criteria and there was no evidence of malunion of the talus (bone that joins with the tibia and fibula to form the ankle joint), surgical removal of the talus (astralgalectomy), impairment of the tibia/fibula with ankle disability, or ankylosis of ankle or foot joints to support a higher rating.  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, coded 5271.

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.  In the matter of the right ankle condition, the Board unanimously recommends a disability rating of 10%, 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	5271	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140111, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX, AR20160002138 (PD201400414)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA