RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00517		
BRANCH OF SERVICE:  Army	BOARD DATE:  20150707
Separation Date:  20061016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Light-Wheel Vehicle Mechanic) medically separated for a left ankle condition.  The left ankle condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Left ankle osteochondral lesion of the talus” 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 secondary to osteochondral lesion of the talus, status post (s/p) arthroscopic drilling of the talar lesion” as unfitting, rated 0%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  She was not evaluated for other conditions.  Her 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/Naval 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 20060915	VA* - (~4 days Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain…	5099-5003	0%	S/P Left Ankle Arthroscopy Debridement…	5271-5010	10%	20061012	
			Scar, S/P Left Ankle Arthroscopy Debridement…	7804	10%	20061012	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8	
RATING:  0%	COMBINED RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20061108 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Left Ankle Condition.  The CI reported left ankle pain in 1997 without a history of trauma.  She fell and sustained a non-displaced fracture of the left 5th metatarsal (part of the toe) in November 2002.  The left ankle CT scan performed in January 2004 showed an osteochondral lesion (cartilage damage or tear) in the ankle (talar dome) along with effusion (swelling).  A left ankle X-ray performed in March 2004 was normal.  A left ankle magnetic resonance imaging study performed in September 2005 showed the osteochondral lesion and an inflamed tendon.  Throughout 2004 to 2006, the CI was followed by orthopedics for chronic left ankle pain.  She underwent a left ankle arthroscopy with subchondral (under cartilage) drilling on 21 October 2005.   Despite conservative and surgical intervention the CI continued to report left ankle pain and physical therapy notes throughout 2005 and 2006 documented joint pain localized to the left ankle and a poor response to aggressive treatment.  The commander’s statement in May 2006 documented that the left ankle condition prevented the CI from performing the duties of her MOS without extensive pain and the possibility of further injury.  The MEB Narrative Summary (NARSUM) exam approximately 3 months prior to separation documented left ankle pain and an inability to run or do long marches.  The examiner opined that the CI failed treatment and there were no further orthopedic intervention options.  Physical therapy range-of-motion (ROM) and MEB physical exam findings are summarized in the chart below.  The VA Compensation and Pension (C&P) exam 4 days before separation documented a history of chronic left ankle pain.  The examiner opined that the CI’s total functional loss equated to dorsiflexion limited to 30 degrees and mild physical impairment during flare-ups.  The examiner also opined that repetitive use and motion would result in mild physical limitation; mostly associated with pain and lack of endurance.  The VA C&P physical exam findings are summarized in the chart below.  There were ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.  

Left Ankle ROM
(Degrees)	
PT ~3 Mo. Pre-Sep
	
MEB ~3 Mo. Pre-Sep
	
VA C&P ~4 days Pre-Sep
	
Dorsiflexion (20 Normal)	-5 -5 0		15	
Plantar Flexion (45)	30 35 40		35	
Inversion 35-45	20,25,25		35	
Eversion15-25	30,35,35		15	
Comment	Goniometer used; Pain with dorsiflexion	Sensory nml; no pain on ROM; strength nml; TTP with flexion; pain was elicited when passively flexed into PF	antalgic gait;  Unable to walk briskly; Pain with ROM;  slight; mild TTP; strength 4/5 (ankle weakness), sensory 2/4; severe ankle deviation inwardly; some instability when walking; mild pain and stiffness	
§4.71a Rating	20%	 10% (0%)	10% (VA 10%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 0%, coded 5099-5003 (Arthritis, degenerative [hypertrophic or osteoarthritis]).  The VA rated the condition 10%, coded 5271-5010 (Ankle, limited motion of-Arthritis, due to trauma, substantiated by X-ray findings).  The Board considered whether the evidence supported a higher than 0% rating for the chronic left ankle pain condition.  The Board noted the marked difference between the MEB ROM 3 months prior to separation and VA ROM performed 4 days after separation.  The Board placed higher probative value on the VA exam because it was most proximate to separation and therefore; most closely approximates the functional limitations associated with the left ankle condition at the time of separation.  The Board determined that the 5 degrees decrease in ankle dorsiflexion and 10 degrees decrease in plantar flexion met VASRD code 5271 (ankle limitation of motion) criteria for moderate limitation of motion.  The slightly antalgic gait, ankle weakness and pain also met criteria for a 10% rating IAW VASRD 4.59 (Painful motion). The Board also considered analogous rating under code 5284 (foot injuries, other), but determined that this would not result in a higher than 10% 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 left ankle condition coded 5271-5010.  

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 5271-5010 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 Pain	5271-5010	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150013360 (PD201400517)

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,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization 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:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA