RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-01342
BRANCH OF SERVICE: Army 	      SEPARATION DATE:  20081014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard, E-3, Basic Trainee, medically separated for “right ankle, limited motion,” rated at 20%.

CI CONTENTION:  The CI contends for his ankle and a number of conditions not identified by either the MEB or PEB.  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 - 20080919	VARD - 20100217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle	5271	20%	Residual Bimalleolar Fx of the Right Ankle w/Residual Scar	5271	10%	20091104	
COMBINED RATING:  20%	COMBINED RATING FOR ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to service treatment records and the MEB narrative summary (NARSUM), the CI underwent right ankle surgery in May 2008 to repair a fracture incurred while in basic training.  Despite treatment, the CI’s ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty because he was still using crutches and a CAM-walker for ambulation.  He was referred for a Medical Evaluation Board (MEB) in July 2008.  

At the MEB NARSUM examination on 9 July 2008, 2 months after surgery and 3 months prior to separation, the examiner recorded that the CI continued to have pain in his right ankle, difficulty regaining his ROM, and was using crutches and a CAM-walker boot.  On examination he had well-healed surgical scars, moderate swelling, tenderness, and a ROM that was both limited by pain and a mechanical block as indicated in the chart above.  At the time of the orthopedic clinic appointment on 11 August 2008, 2 months prior to separation, the CI reported that he felt things were improving with his right ankle. On examination the CI had tender, but well-healed surgical scars and limited motion as indicated in chart above.  The orthopedic surgeon noted X-rays (11 August 2008) fractures to be healed with good alignment and position.  At the time of the physical therapy clinic appointment on 22 September 2008, a month before separation, the CI reported that he continued to have pain in the area of the hardware screws. On examination the CI had swelling, tenderness around the surgical scars and around the ankle joint, and had improved but still limited motion as indicated in chart above.  At the time of the orthopedic clinic appointment on 20 November 2008, a month after separation, the CI reported that his ankle was tender, painful with dorsiflexion, bothersome with walking and prevented running.  On examination the CI presented without the use of assistive devices, had well-healed surgical scars, and had limited motion in all planes as indicated in chart above.  X-rays showed healed fractures with good alignment, no hardware complications, and mild loss of bone density consistent with decreased use after surgery.  The orthopedic surgeon concluded the CI was continuing to make progress and advised continued physical therapy.  According to VA records the CI underwent surgery in September 2009 to remove the orthopedic hardware from the right ankle.  At the VA Compensation and Pension (C&P) examination for the feet on 16 October 2009, 12 months after separation, the CI was noted to be wearing an ankle brace with a normal gait without assistive devices.  At the VA C&P examination performed 4 November 2009, performed 13 months after separation, the CI reported that he was having right ankle pain and swelling that affected the motion of the ankle join.  Physical examination showed no soft tissue abnormalities, minimally tender scar, an antalgic gait, painful motion, and limited motion of dorsiflexion to 5 degrees and plantar flexion to 30 degrees.  There was no additional limitation after repetitive movement.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, coded 5271 (limited motion of the ankle), citing painful motion and limitation of motion with diffuse tenderness.  The VA rated the right ankle condition 10%, coded 5271 (limited motion of the ankle), citing painful motion.  The Board noted that the PEB assigned the maximum rating (20%) available under the diagnostic code 5271.  The Board considered whether a higher rating was supported under other diagnostic code options.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 20% rating adjudicated by the PEB.  The Board also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (VASRD §4.7) however all Board members agreed that the severe level (30%) was not supported.  The Board did not find a preponderance of evidence that a tender or painful scar separately interfered with duty and therefore a separately ratable scar condition is not recommended.  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 20140225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 JUL 2016

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, AR20160005892 (PD201401342)

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