RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-00474
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140814
SEPARATION DATE:  20060428

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (3PX/Security Forces Tech Student) medically separated for a left ankle problem.  The ankle could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards and she was referred for a Medical Evaluation Board (MEB).  The ankle condition, characterized as “left ankle pain status post (s/p) trimalleolar fracture with open reduction and internal fixation (ORIF),” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated left ankle pain, s/p ORIF trimalleolar fracture as unfitting rated 0%, with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION: “Having difficulties walking picking things up doing daily activities.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting ankle condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her, but must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

RATING COMPARISON:

Service IPEB – Dated 20060310	VA* - (9 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle….	8799-8727	0%	Residuals of L Ankle Fx	5003-5271	10%	20070129	
Other x 0 (Not in Scope)	Other x 0 (Not in Scope)	20070129	
Combined:  0%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20070207 (most proximate to date of separation)

ANALYSIS SUMMARY:

Left Ankle Condition.  The narrative summary (NARSUM) notes the CI sustained a complex fracture of her left ankle (trimalleolar fracture) during security force training in 2005.  The ankle condition was operatively repaired with the placement of a plate and screws (hardware) on 
17 February 2005.  Post-operatively the CI did well following rehabilitation.  X-rays images of the ankle on 8 June 2005, revealed the fracture sites to be healing and only general compromise of the hardware.  On the orthopedic evaluation on 27 September 2005, the CI elaborated her desire to remain in the Air Force and denied any problem with the ankle, to include residual pain and stiffness.  On physical examination, the surgical sites were well healed.  Range-of-motion testing of the ankle revealed plantar flexion (PF) of 30 degrees (normal, 45 degrees) and dorsiflexion (DF) of 5 degrees (normal: 20) without pain or ankle instability.  The ankle condition was deemed healed and the CI was cleared for return to training without restriction.  X-rays images of the ankle 13 December 2005, revealed good healing of the fracture sites, no arthritis, the screws and plate are securely in place.  In the interval between September 2005 and January 2006, the CI developed ankle pain with activity.  On 9 January 2006 the CI was seen in the clinic where continue ankle pain was described.  Gait at that time was normal.

At the MEB NARSUM evaluation performed on 19 January 2006 (3 months prior to separation), the CI reported left ankle pain with running, standing and walking.  No physical examination was recorded.  The examiner diagnosed left ankle pain s/p ankle fracture and repair.

During the VA Compensation and Pension exam performed on 29 January 2007 (9 months after separation), the CI reported pain, weakness, stiffness and instability of the left ankle.  The CI noted little impact of this condition on her activities of daily living except pain with lifting items greater than 15 pounds and reported taking no prescribed medication for the ankle condition.  On physical examination, gait was normal without need for crutches.  Tenderness to palpation of the ankle was present.  Ankle motor strength, sensory and reflex exams were normal.  Surgical scars were well healed without irritation or tenderness.  X-ray images of the ankle revealed healed fractures with minimal arthritis but evidence of loosened hardware.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition at 0% using code 8727 (neuralgia of internal saphenous nerve, mild to moderate) for ankle pain.  No higher rating is achievable under this code IAW §4.124.  The VA rated the ankle condition at 10% under code 5271 (ankle, limited motion, moderate) for painful motion.  A higher rating under this code requires evidence of marked limitation of motion.  The Board unanimously agreed that the ankle condition rose to the level of a 10% rating for painful motion IAW §4.50 and §4.59.  The Board agreed that the evidence in record did not support a 20% under code 5271 as limitation of motion was not “marked.”  The Board next considered a rating under codes 5270 and 5272 for ankylosis; however, there was no objective evidence of ankylosis or of poor weight bearing of the ankle to support this rating.  The Board agreed that the record supported no rating for painful scars under code 7804 IAW §4.118.  The Board found no other appropriate codes for consideration.  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 left 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 left ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5003-5271 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 her prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
Left Ankle	5003-5271	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140114, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-00474.

	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,

XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachments:
1.  Directive
2.  Record of Proceedings

cc:
SAF/MRBR
DFAS-IN