RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01888
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20051123	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Infantryman, medically separated for “right ankle pain,” with a disability rating of 10%.

CI CONTENTION: The applicant contends for his unfitting ankle 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 - 20051007	VARD - 20051205	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Chronic Right Ankle Pain
	5009-5003	10%	S/P ORIF of Right Weber C Ankle Fx w/Placement of Syndesmotic Screw	5099-5010	10%	20051102	
			Surgical Scar, Right Ankle	7801	0%	20051102	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right ankle surgery using a plate and three screws in April 2003 for a Weber C-type closed ankle fracture of the distal fibula with disruption of the mortise (part of the distal tibia joining the talus bone to form an ankle joint) consistent with a ligamentous tear, which occurred during combat when he injured his right ankle.  Despite treatment by physical therapy and removal of one screw in early 2004, 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 an MEB.  The MEB forwarded “right ankle, s/p distal fibula fracture, closed, with ORIF (open reduction internal fixation)” for PEB adjudication.  An orthopedic evaluation in April 2005 noted a slight decrease in the range of motion (ROM) lacking 10 degrees of plantar flexion compared to the left with tenderness throughout and strength was 3+/5.  The NARSUM, written in August 2005, 6 months prior to separation, indicated that the CI reported continued ankle swelling with walking, standing or marching, and that he was unable to run or jump.  Physical examination noted slight right ankle swelling and tenderness to palpation.  X-rays of the right ankle in October 2004 showed three cortical screws in the distal fibula and no visible fracture line, good normal mineralization, and no significant deformity.

At the VA Compensation and Pension (C&P) examination in November 2005, performed 3 weeks before separation, the CI reported ankle pain when standing for longer than 20 minutes with no incapacitation.  Physical examination showed no tenderness or any deformity; motor and sensory examinations were normal.  

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.

Right Ankle ROM
(Degrees)	Ortho ~ 7 Mo. Pre-Sep
	MEB ~ 03 Mo. Pre-Sep
	VA C&P ~ 3 Weeks Pre-Sep
	
Dorsiflexion (20 Normal)		2 degrees from neutral	20	
Plantar Flexion (45)	35	30	45	
Comment	No swelling, erythema, warmth, 
or deformity; slight tenderness to palpation; negative anterior drawer and talar tilt	Slight swelling, tenderness to palpation over the right medial malleolus over the medial pretibial area and over the dorsal right foot	Joint function additionally
limited by pain after 
repetitive use	
§4.71a Rating	10%	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA also assigned a 10% rating using an analogous 5099-5010 code (arthritis, due to trauma, substantiated by X-ray findings) based on the VA C&P examination 3 weeks before separation, citing painful or limited motion.  The VA then assigned a 0% rating using the 7801 code (burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear) for a surgical scar (not in the scope of review) citing the absence of deep scars or scars that cause limited motion with an area or areas exceeding 6 square inches (39 sq. cm).  The Board discussed the differences in ROM measurements between the NARSUM and VA exams, and determined that the VA examination had a greater probative value as it was just prior to separation.  Therefore, there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by both the PEB and VA.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and 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 ankle condition.

BOARD FINDINGS:  In the matter of the 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 no re-characterization of separation or modification of the disability rating previously assigned.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140425, 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 XXXXXXXXXXXXXXXXXXXX, AR20160007467 (PD201401888)

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