RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01503
BRANCH OF SERVICE:  Army	BOARD DATE:  20141209
SEPARATION DATE:  20080904

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B/Infantry) medically separated for a right ankle condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right ankle condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also forwarded “post-concussion and sleep disorder,” to the PEB as medically acceptable.  The Informal PEB adjudicated “right ankle pain” as unfitting, rated at 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) §4.59.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting ankle condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – dated 20080521	VA – (8 mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5099-5003	10%	Status Post Right Ankle Fracture 	5271	0%	20071204	
Other x 2 (Not In Scope)	Other x 7	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20090114 (most proximate to date of separation)

ANALYSIS SUMMARY:

Right Ankle Pain.  In February 2005, the CI fractured his right ankle during combative training and underwent open reduction and internal fixation with a cast placement for 8 weeks.  When the cast was removed, he began physical therapy (PT).  The CI deployed to Iraq from November 2005 to November 2006, during this deployment he began to experience the right ankle pain that progressively worsen.  After his return to the US, he was treated with exercise, medication and joint injection.  However, the ankle pain persisted and an MEB was initiated.  During VA Compensation and Pension exam in December 2007, the CI reported his right ankle pain was aggravated by running, walking, bearing weight and weather changes.  On physical examination (PE) of the right ankle, the examiner noted there was no tenderness to palpation, gait and heel/toe walking was normal.  Range-of-motion (ROM) and muscle strength were normal.  There were no limitations in ROM from fatigue, weakness, lack of endurance or pain.  The MEB narrative summary, dictated on 31 March 2008, the CI complained of constant right ankle pain that was worse with running or prolonged standing.  On PE, there was some tenderness of the lateral malleolus, but no joint swelling.  Neurological exam (motor and sensory) was normal.  ROM testing showed mild limitation of inversion, eversion, and dorsiflexion due to pain.  .  The ROM measurements, obtained on 1 May 2008, by PT were the following:

Right Ankle ROM
(Degrees)	VA C&P ~ 9 mos. Pre-Sep
(20071204)	PT ~ 4 mos. Pre-Sep
(20080501)	
Dorsiflexion (20 Normal)	20	85	
Plantar Flexion (45)	45	30	
§4.71a Rating	10%*	10%*	
	*10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion)

The Board carefully examined all available evidence and directs attention to its rating recommendation.  The Army PEB and the VA chose different coding and rating options for the right ankle condition.  The Board considered the results of the two ankle ROM examinations shown above.  At both exams, the CI had right ankle dorsiflexion of 20 degrees (or greater) and right ankle plantar flexion of 30 degrees (or greater).  It was documented in the treatment record that the CI’s gait was normal.  After a thorough review of the evidence, the Board determined that the right ankle condition was essentially non-compensable based solely on the VASRD §4.71a codes 5270 through 5274, for the ankle.  However; IAW VASRD §4.40, §4.45, and §4.59, a part of the musculoskeletal system which becomes painful on use must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  All Board members agreed that a rating of 10% was appropriate for the right ankle condition.  The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a disabling ankle condition which would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends no change to the PEB adjudication of the unfitting right ankle condition.  IAW VASRD §4.40, §4.45, and §4.59, the right ankle meets criteria for a 10% rating due to painful motion of a major joint.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right ankle condition and IAW VASRD §4.40, §4.45 and §4.59, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  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 20140316, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				XXXXXXXXXXXXXXX
				President 
				Physical Disability Board of Review

	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 XXXXXXXXXXXXXXX, AR20150007569 (PD201401503)

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:

Encl			     XXXXXXXXXXXXXXX
				     Deputy Assistant Secretary of the Army
				          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA