RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01328
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “chronic left ankle pain” with a disability rating of 0%.

CI CONTENTION: The applicant contends for his unfitting condition.  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 - 20060117	VARD - 20060808	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5003	0%	Instability, Left Ankle	5257	10%	20060524	
			Osteoarthritis, Left Ankle, S/P Arthroscopy for Osteochondritis Dissecans	5010-5271	10%	20060524	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:

Chronic Left Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left ankle surgery in May 2005 for osteochondritis dissecans.  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 a MEB.  The MEB forwarded “chronic left ankle pain secondary to osteoarthritis of the left ankle status post removal of osteochondritis dissecans lesion” for PEB adjudication.  At an orthopedic visit in September 2005, 6 months prior to separation, the examiner noted full active range of motion (ROM), mild effusion, and anterior joint line tenderness.  There was no instability or erythema.  At the MEB NARSUM examination, dated October 2005, 5 months prior to separation, the CI reported left ankle pain lasting all day exacerbated by standing for a long period of time  Physical examination noted  a slightly antalgic gait, moderate pes planus, swelling, and tenderness along the lateral  malleolus.  There was no erythema or muscle atrophy.

At the VA Compensation and Pension (C&P) examination in May 2006, performed 3 months after separation, the CI reported persistent left ankle pain.  Physical examination showed an antalgic gait with swelling, effusion, tenderness, joint laxity, and instability.  There was no ankylosis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under code 5003 (degenerative arthritis), citing osteoarthritis without ratable limitation of motion.  The VA assigned a 10% rating using an analogous code 5010-5271 (arthritis, due to trauma, substantiated by X-ray findings and ankle, limited motion of) based on the VA C&P examination 3 months after separation, citing moderate limited motion of the ankle.  The VA also assigned a 10% rating using code 5257 (knee, other impairment of) citing slight instability of the left ankle.  The physical therapy examination in October 2005 showed a limitation of dorsiflexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  The MEB examination, 9 days after the physical therapy examination evidenced of painful motion causing functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The VA examination was the only examination to identify instability; therefore, after due deliberation and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend an additional disability rating for instability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the left ankle condition, coded 5271.

BOARD FINDINGS:  In the matter of the left ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior to medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Ankle Pain	5271	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140313, 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 XXXXXXXXXXXXXXXXXXXX, AR20160006673 (PD201401328)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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:

CF: 
(  ) DoD PDBR
(  ) DVA