RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00956
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated by the Informal Physical Evaluation Board (PEB) for “chronic right ankle pain with limited range of motion” with a disability rating of 10%.  

CI CONTENTION: The applicant makes no specific contention in their application.  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 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 - 20080516	VARD - 20100726	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain with Limited Range of Motion	5271	10%	Chronic Right Ankle Pain Due to Residual of Osteochondral Defect and Fragment	5271	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain Condition.  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in Basic Training in November 2007 as a consequence of inversion injury.  Constant pain led to radiographic evaluation that showed an osteochondral defect of the talus (damage to a piece of cartilage and underlying bone in an ankle bone).  Arthroscopy in March 2008 (3 months prior to separation) showed somewhat soft but intact cartilage; therefore debridement or other specialized surgical techniques were not performed.  Despite conservative treatment and activity restriction, ankle pain did not improve sufficiently to allow return to training.  

The MEB examination (on the DD Form 2808) in April 2008 (2 months prior to separation) noted the presence of painful right ankle pain motion during eversion.  At the MEB NARSUM exam performed in May 2015 (a month before separation) the CI reported having pain daily with flare ups 3-5 times per week when she moved her ankle the wrong way, pivoted or walked for prolonged periods.  The flares lasted 5-10 minutes.  She could not run any distance and used over-the-counter pain medication; oral narcotics were used only during flare ups.  Examination showed ambulation without difficulty, and no evident discomfort getting off and on the examination table.  Although it was stated that no bony or soft tissue tenderness was present, areas of tenderness over both malleoli was noted.  There was no swelling or muscle atrophy.  An anterior drawer test was negative for ankle instability.  Surgical scars over the medial and lateral ankle were well healed.  Goniometric range-of-motion (ROM) measurements were repeated three times and showed right ankle dorsiflexion of 15 degrees (normal 20 degrees) and plantar flexion of 20 degrees (normal 45 degrees).  Pain at end ROM was present, but there was no functional loss due to fatigue, weakness, lack of endurance or incoordination.  Strength was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10% coded 5271 (limited motion of the ankle), citing limited ROM with consideration of VASRD §4.40 (functional loss) and §4.59 (painful motion).  The VA rated the right ankle condition 0% coded 5271 (limited motion of the ankle).  The Board agreed that the ROM examination proximate to separation detailed above was consistent with a moderate limitation of motion for the 10% rating under this code.  A higher rating of 20% was not indicated in the absence of marked limited ROM.  There was no ankylosis to support a minimum rating under the respective code (5270).  VASRD diagnostic code 5273 (malunion of the talus) provides for a 20% rating for marked deformity; however, the Board did not find evidence of marked deformity of the talus.  The Board considered alternative VASRD ankle and analogous codes, but they were not applicable or 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 chronic 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.  

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, 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, AR20160005442 (PD201400956)

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