RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01241
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080703

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Nuclear Medicine Specialist, medically separated for “left ankle injury,” with a disability rating of 20%.

CI CONTENTION:  The CI requests consideration for a shoulder injury that was not listed in the MEB, and also indicates he disagrees with the adjudication of the ankle, reporting it is still painful and limits physical activity.  The CI’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 - 20080325	VARD - 20080926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Injury	5271	20%	S/P Surgery, Left Ankle…	5270	30%	20080520	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Ankle Injury.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in July 2006 while playing softball.  Imaging studies performed on 04 August 2006 revealed bone bruises within the left ankle and heel as well as soft tissue inflammation.  Surgical debridement was performed on 27 March 2007.  Despite surgery, physical therapy, rehabilitation, and medication, his condition did not improve.  The MEB forwarded “chronic left ankle pain status post Bassets ligament/anteromedial synovitis left ankle/osteochondral lesion left talus” for PEB adjudication.  

At the MEB examination dated 27 December 2007 (6 months prior to separation), the CI reported continued left ankle pain aggravated by walking, twisting, and climbing stairs.  His physical examination (PE) revealed limited ROM as well as tenderness and a mild effusion of the left ankle joint.  Examination for ligamentous instability was negative.  At the VA Compensation and Pension (C&P) examination on 20 May 2008 (1 month before separation), the CI reported constant left ankle pain aggravated by physical activity and resulted in weakness, stiffness, swelling, heat, pain, give way, and localized lack of endurance.  The pain was relieved by medication; however, he reported the ability to function without medication.  The VA PE revealed a normal gait and swelling of the left ankle.  Left ankle strength was assessed as 1/5 with 5 being full strength.  His left ankle ROM was severely limited and measured no further than a neutral position of 0 degrees.  The VA documented, ‘[The CI]…essentially lost the use of left ankle’.  Additionally, there was gross atrophy (muscle wasting) of the left leg, so that the circumference around the lower leg measured 4 centimeters less on the left compared to the right leg.  The provider attributed the smaller size of the left leg with the near complete immobility of the left ankle.  X-ray studies performed in September 2008 showed no fractures, dislocations, foreign bodies, or erosive bony lesions.  

The 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)	MEB ~6 Mo. Pre-Sep
(20071227) 	VA C&P ~1 Mo. Pre-Sep
(20080520) 	
Dorsiflexion (20)	-4	0	
Plantar Flexion (45)	25	0	
Comments	painful motion; 
uses walker	essentially lost the use of left ankle	
§4.71a Rating	20%	20%-30%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 20% coded 5271, (limited motion of the ankle), citing limitation of motion and pain.  The VA rated the left ankle condition 30% coded 5270 (ankle, ankylosis), citing limitation of motion.  The Board first focused on the most probative examination (VA C&P) due to its close relationship to the CI’s date of separation and considered if the provider’s comment of ‘essentially lost the use of left ankle’ would equally support the definition of an ankylosed joint and therefore, be considered under VASRD code 5270 (ankle ankylosis).  Members concluded that the mere presence of some (albeit minimal) ankle motion did not support a rating under the ankylosis 5270 code.  In light of the significant limitation of motion, all Board members agreed that code 5271 (ankle; limitation of motion) was supported at the highest level of ‘marked’ 20% impairment.  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:  In the matter of the left ankle condition, 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 20140308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160010054 (PD201401241)

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