RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00504
BRANCH OF SERVICE:  Army	BOARD DATE:  20151030
SEPARATION DATE:  20041017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active E-6 (Light Vehicle Mechanic) medically separated for left ankle pain.  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 “chronic left ankle pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic left ankle pain” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  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 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 20040804	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5099-5003	10%	Left Ankle Ligament Tear…	5271	10%	20050107	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20050330(most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain Condition.  The CI twisted his left ankle while running on 8 July 2003.  An X-ray was normal other than soft tissue swelling.  He was treated conservatively with duty restrictions, medications, and physical therapy (PT).  He had slow improvement and an MRI on 8 October 2003 showed some degenerative disease of an ankle bone (talar dome).  He was referred to orthopedics on 14 October 2003 and treated with immobilization.  His symptoms persisted and he then underwent surgery on 2 December 2003.  The CI was progressing in rehabilitation until he reinjured his ankle in March 2004.  A repeat MRI on 29 May 2004 noted an improved appearance of the talar dome.  Despite further rehabilitation, he was not able to return to full duty.  In PT on 25 June 2004, the range-of-motion (ROM) was decreased bilaterally from VA normal values, but more on the left as charted below.  The gait was non-antalgic (implying normal).  At the MEB examination on 6 July 2004, the CI was noted to have full active ROM of the left ankle with pain.  The narrative summary (NARSUM), dated 14 July 2004, documented that the CI could not march, run, or carry over 10 pounds.  The ROM was slightly reduced for plantar flexion (toes down) and dorsiflexion (toes up).  The ankle was stable, but tender to palpation.  The dictating orthopedic surgeon described two torn ligaments on the second MRI; one was specifically noted as intact by the radiologist.  The NARSUM was not consistent with the hand written note from the same day and appears to be written in error.  The Board noted that the interpretation by the radiologist is consistent with the stable examination documented by the orthopedic surgeon.  The gait was not recorded.  At the VA Compensation and Pension (C&P) examination performed on 7 January 2005, 3 months after separation, the CI reported ongoing pain, but no limitations in his occupation as a mechanic.  On examination, the ROM was painless and reduced 10 degrees in plantar flexion.  There was minimal tenderness and swelling.  Repetition caused no further limitation in motion.  Instability and gait were not specifically commented upon, but it was noted that there was “no deformity.”  X-rays were normal.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Left Ankle ROM
(Degrees)	PT ~4 Mo. Pre-Sep	MEB ~3 Mo. Pre-Sep	VA C&P ~3 Mo. Post-Sep	
Dorsiflexion (20 Normal)	11-12	15	0-20	
Plantar Flexion (45)	35	35	0-35	
Comment	Right DF 15; PF 42	Right side normal	Painless motion	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the ankle at 10%, coded 5099-5003 (analogous to degenerative arthritis) and 5271 (moderate limitation of motion of the ankle), respectively.  The Board considered the evidence and found no route to a higher 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:  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 chronic left ankle pain 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.  

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 2014-00504, 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 XXXXXXXXXXXXXXXXXXXXXX, AR20160000228 (PD201400504)

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