RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02912
BRANCH OF SERVICE:  Army	 SEPARATION DATE:  20081125

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Basic Trainee) 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 MEB forwarded “chronic pain, right ankle after fracture, ORIF” as medically unacceptable to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  
The Informal PEB adjudicated “degenerative arthritis, right ankle” as unfitting, rated 10% with application of 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 20081104	VA* - (~2 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Right Ankle	5003	10%	Residuals, Fracture of Right Fibula	5262-5271	10%	20090106	
Other x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20090126 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Ankle.  The CI sustained a fracture of the right ankle while in training on 9 June 2008.  He had an open reduction and internal fixation (ORIF) of the right ankle.  Post-operative X-rays showed good alignment with a preserved ankle joint.  He was entered into rehabilitation and made good progress.  One screw was removed on 25 September 2008 with an increase in ankle pain following the procedure.  The narrative summary was 4 months post-ORIF, a month after the screw removal, and a month prior to separation.  On examination, the ankle was still swollen from the surgeries and stiff to movement.  The CI was using a CAM walker (which provides support to the ankle) and crutches.  Edema and atrophy were present.  Neither sensory nor muscular abnormalities were present though.  The range-of-motion (ROM) was recorded as normal.  At the VA Compensation and Pension podiatry examination performed 2 months after separation and 7 months after surgery, the CI reported stiffness, swelling, and a lack of endurance.  He could run, but not as far as before.  He used an ankle brace when his pain flared, but otherwise did not use an assistive device.  Incapacitation was not documented after the acute injury period and recovery from the surgery.  He denied inability or locking and did not have a limp.  Mild swelling was present.  The ankle was stable to examination without an effusion or weakness.  The goniometric 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 ~1 Mo. Pre-Sep	PT ~1 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
Dorsiflexion (20 Normal)	0	3,3,5 (Left 5, 5, 5)	7 (Left 15)	
Plantar Flexion (45)	40	45,45,45 (Left 50, 50, 50)	32 (Left 40)	
Comment		Painful motion	Pain at end motion	
§4.71a Rating	10%	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the right ankle at 10% using the codes 5003 (degenerative arthritis) and 5262-5271 (impairment of the tibia and fibula and limited motion of the ankle), respectively.  The Board found no route to a higher rating.  While the CI did have limited motion on the right, the non-injured left side also had motion less than VA normal values although it was less limited.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination 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 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.

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 20140609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

0 6 JUL 2016

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160003294 (PD201402912)

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