RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02395
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030724

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Combat Engineer, medically separated for a right ankle condition.  The Informal PEB adjudicated his ankle as unfitting, rated 10%.    

CI CONTENTION:  “Please consider all conditions.” 

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 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/Naval 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: 

IPEB – Dated 20030402	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	Residuals Of Post-Traumatic Arthritis, Slight Deformity and Scar; S/P Torn Right Ankle Ligaments With a Proximal Fibula Fracture; S/P Closed Reduction Internal Fixation	5299-5010	10%	20030522	
Other x 0 (Not In Scope)	Other x 5	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20030725 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Right Ankle Condition.  According to service treatment records and the MEB narrative summary (NARSUM), the CI underwent right ankle surgery in February 2002 for an ankle fracture and ligament tear from a parachute landing fall.  In May 2002 he had the hardware removed from his ankle, but despite months of physical therapy, his ankle condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and so he was referred for a Medical Evaluation Board (MEB).  At the time of the orthopedic clinic appointment on 22 October 2002 (9 months prior to separation), the examiner recorded that the CI had developed ankle pain.  On examination, he noted mild swelling and tenderness with limited ROM as charted above.  At the MEB examination (recorded on DD Form 2807 and 2808) dated November 2002, 8 months prior to separation, the CI reported chronic right ankle pain that increased during impact activities.  Physical exam showed pain with turning his foot outward and limited ROM.  At the MEB NARSUM exam, dated 25 February 2003 (5 months prior to separation), the CI reported he had great difficulty walking on unstable or uneven surfaces, but that he could walk 1 or 2 miles if he didn’t wear equipment or carry loads.  On examination, he had normal strength in his ankle with no gait abnormality.  However, there was swelling and tenderness, limited ROM along with painful motion when he moved his ankle in any direction.  At the VA Compensation and Pension (C&P) examination on 22 May 2003, 2 months prior to separation, the CI reported that his right ankle did not interfere with his posture or gait.  Physical exam showed normal gait, no muscle or bone tenderness or atrophy, no swelling, and pain-free motion to the VA normal limits.  There was a well healed, non-tender scar and deformity of the ankle (medial malleolus).  Radiographs documented posttraumatic arthritic changes.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10% (coded 5099-5003), citing moderate and frequent pain.  The VA rated the right ankle condition 10% (coded 5299-5010, arthritis, due to trauma, substantiated by X-ray findings), citing multiple residual complications to include deformity, arthritis, and scar.  Painful motion on the MEB exam would warrant a 10% rating IAW VASRD §4.59.  The Board considered if the service-documented limitation of motion was moderate (10%) or marked (20%) when considered under 5271, limitation of ankle motion.  The Board agreed that the ROM examinations proximate to separation detailed above were most consistent with a moderate limitation of motion for the 10% rating under this code.  The Board noted the ankle ROMs documented by C&P examination proximate to separation were normal.  All Board members agreed the ankle limitation of motion was no more than moderate supporting the 10% rating adjudicated by the PEB.  A higher rating of 20% was not indicated in the absence of marked limited ROM of the ankle.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  Because there was no nonunion or malunion of the tibia or fibula, VASRD 5262 does not yield a rating higher than the 10% adjudicated by the PEB providing no benefit to the CI.  The Board reviewed service treatment records and did not find evidence that a tender or painful scar separately interfered with duty and therefore a separate rating was not recommended for the CI’s surgical scar.  

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.  

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 20140509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXX AR20160004494 (PD201402395)

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 
( ) OVA