RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00839
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Combat Engineer, medically separated for “chronic right ankle pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI makes no specific contention.  The applicant’s 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 Physical Evaluation Board (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:  

SERVICE PEB - 20090909	VARD - 20100609	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5010	10%	Right Ankle Strain	5271	0%	20100511	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Right Ankle Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in June 2007 when his foot was slammed in a door.  Radiographic studies (X-ray) in September 2008 noted soft tissue swelling and mild calcaneal spurring.  A bone scan in September 2008 showed stress induced changes at the right proximal tibiofibular joint.  A magnetic resonance imaging (MRI) in October 2008 was normal.  At the time of the orthopedic examination on 30 June 2009, the examiner recorded full range-of-motion (ROM), normal strength and anterior and posterior drawers were negative.  An X-ray in July 2009 noted mild degenerative changes with a medium size plantar calcaneal spur.  
Despite treatment, the ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “chronic right ankle pain” for PEB adjudication.  

At the MEB odiatry NARSUM examination, the CI reported pain worse with physical activity, averaging 6/10 and complained of swelling and constant tingling symptoms.  He denied locking or giving way sensations.  On examination there was tenderness on palpation and pain was elicited by motion.  There was no swelling or instability and strength was normal.  The treatment note record for the MEB NARSUM stated:  “Normal gait.  Heel, toe, and tandem walks are performed with ease.”  

At the VA Compensation and Pension (C&P) examination in May 2010, 5 months after separation, the CI reported intermittent pain and used an ankle brace.  Physical examination showed a normal gait with non-painful limited ROM.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5010 code (arthritis due to trauma, substantiated by X-ray findings), citing limitation of a major joint.  The VA assigned a 0% rating using the 5271 code (limited motion of the ankle) based on the VA C&P examination 5 months after separation, citing limitation of motion was not “moderate” and there was no painful motion.  The ankle limitation of motion at the MEB and the VA C&P examinations was slight and did not approach the moderate limitation required for a 10% rating under diagnostic code 5271 for limitation of ankle motion.  However there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to 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 right ankle condition.  

BOARD FINDINGS:  In the matter of the right 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 20140219, with attachments
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, AR20160005833 (PD201400839)

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