RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-00455
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Administrative Specialist, medically separated for “chronic left ankle pain and weakness,” with a disability rating of 20%.  

CI CONTENTION:  Her condition continues to worsen and negatively impact her daily activities.  The applicants complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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:  

SERVICE PEB - 20060623	VARD - 20080102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain and Weakness	5271	20%	Left Ankle, Post-Operative	5271	20%	20070821	
RATING:  20%	RATING:  40%	

ANALYSIS SUMMARY:  

Left Ankle Condition.  The CI had a long history of multiple left ankle injuries that required two ligament reconstruction surgeries to be performed in February 2003 and November 2004.  Recovery complications included additional diagnoses of complex regional pain syndrome (CRPS) and or reflex sympathetic dystrophy (RSD) which required further invasive central and peripheral nerve blocks.  Despite such treatment as well as aggressive physical therapy (PT) and restrictive activities, her left ankle pain persisted.  She was permanently profiled in June 2006 and referred to a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARSUM) examination performed on 20 April 2006 (7 months pre-separation) the CI reported continuing ankle pain.  Her physical examination (PE) revealed decreased and painful motion of the left ankle.  The examiner’s prognosis included, “…unlikely [the CI] will be able to return to duty as a soldier in the US Army.  It is likely she will continue to experience pain in one degree or another for the rest of her life and she is likely to develop post-traumatic arthritis of the left ankle.”  Her pain was assessed as ‘moderate’ and ‘constant’.  At the VA Compensation and Pension (C&P) examination performed on 21 August 2007 (9 months post-separation) the CI reported a burning, aching, sharp, and cramping left ankle pain aggravated by physical activities and stress.  Her symptoms occurred three times per week and lasting 30 minutes each occurrence.  The VA PE was detailed noting severe decrease in dorsiflexion and tenderness about the left ankle.  
The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the left ankle condition at 20% impairment under VASRD code 5271 (Ankle; limited motion).  The Board first acknowledged that the PEB’s current rating of 20% was the maximum allowed under the VASRD’s limitation of motion code for the ankle.  Members than considered other coding options for a possible higher rating.  Absent evidence of joint ankylosis, no other ankle specific code rated greater than 20%.  VASRD Code 5284 (foot injuries; other) was also considered at moderately severe (20%) or severe at (30%); however, member consensus was that the described prognostic opinion as to the future development of traumatic arthritis indicated that the severity of the CI’s condition (near the time of service separation) was not yet at a ‘severe’ level and was more appropriately considered ‘moderately severe’ thus equating the PEB’s current 20% impairment rating.  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 left ankle condition.

BOARD FINDINGS:  In the matter of the left 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.  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 20131226, 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 XXXXXXXXXXXXXXXXXX, AR20160005526 (PD201400455)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA