RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02460
BRANCH OF SERVICE:  Army	BOARD DATE:  20150128
SEPARATION DATE:  20031120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Light Wheeled Mechanic) medically separated for a right ankle condition.  The right ankle condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards but was authorized to perform an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Right ankle pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic right ankle pain” as unfitting, rated 0% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

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 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 20030909	VA* - (~7 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	0%	Degenerative  Joint Disease, Right Ankle	5271-5010	10%	20040618	
Other x 0 (Not In Scope)	Other x 11 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050208 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Right Ankle Condition.  The CI described hearing a “pop” in his right ankle accompanied with pain while running as part of physical training in June 2001.  Radiologic work-up noted joint fluid about the heel with surrounding tendonitis.  Despite mainstay treatment of physical therapy, immobilization, pain medication, and activity restrictions, his painful symptoms remained.  He was permanently profiled in October 2002 and underwent an MEB.  At the MEB narrative summary examination (performed 4 months prior to separation), the CI reported right ankle pain with weight-bearing or upon ambulation.  The MEB physical examination (PE) noted decrease range-of-motion (ROM) and tenderness on the outside of the right ankle.  Guarding (involuntary muscle contractions due to pain) was present upon side-to-side ankle motion.  There was no evidence of instability.  The examiner stated, “The [CI] currently has difficulty ambulating, secondary to ankle pain.”  At the VA Compensation and Pension examination (performed 7 months after separation), the CI reported right ankle pain associated with weakness, stiffness, occasional swelling and lack of endurance.  His PE revealed near normal, but painful motion of the right ankle.  There was no joint instability.  All motor and sensory parameters 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)	
MEB ~4 Mo. Pre-Sep
	
VA C&P ~7 Mo. Post-Sep
	
Dorsiflexion (20 Normal)	10	20	
Plantar Flexion (45)	30	20	
Comment	(+) guarding	painful motion 	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 0% rating analogous to 5003 (degenerative arthritis) cited “No significant loss of ROM or evidence of joint instability.”  The VA’s 10% rating was under the primary code 5271 (ankle limitation of motion) for “moderate” limitation.  Board members first agreed with the VA’s primary code of 5271.  Both the MEB’s ROM and the VA’s ROM equate to a “moderate” loss of motion, appropriately rated 10%.  Board members also agreed that sufficient evidence of painful motion (expressed either directly or through muscular guarding) was present to support a rating of 10% IAW VASRD §4.59.  Lastly, the Board considered the unilateral code 5284 (other foot injuries) and agreed that the maximum impairment in this case would rate no greater than “moderate”; again, yielding the same impairment of 10%.  In the absence of ankylosis (frozen joint) or astragalectomy (surgical removal of the talus), there are no other available alternate ankle joint codes available.  The only route to a higher rating would be 20% under 5271 for “marked” limitation of motion.  The Board agreed that the preponderance of the ROM evidence was more reasonably characterized as “moderate” in support of a 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right ankle condition.

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, 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.
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Right Ankle Pain 	5271	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140519, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD 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, AR20150010617 (PD201402460)

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,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization 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:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA