RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03150
BRANCH OF SERVICE:  Army	BOARD DATE:  20150514
SEPARATION DATE:  20050824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Air Traffic Control) medically separated for his left ankle.  The ankle condition did not improve adequately to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “left 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 “left ankle pain, status post reconstruction” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “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:

Army IPEB – Dated 20050606	VA* – (~7 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain, Status Post Reconstruction	5271	20%	Peroneal Tendonitis, Left Ankle,  Postoperative Peroneal Retinaculum Repair	5271	10%	20060401	
			Scar, Left Ankle, Residuals of Postoperative Peroneal Retinaculum Repair associated with Peroneal Tendonitis, Left Ankle, Postoperative Peroneal Retinaculum Repair	7804	10%		
Other x 0 	Other x 8	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20060725 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Left Ankle.  In June 2002, this CI injured his left ankle by jumping off a bicycle.  In October 2002, he underwent surgery to repair his torn peroneal retinaculum.  After surgery, the ankle was treated with physical therapy and medications.  However, in spite of all treatment efforts, he continued to have persistent pain in the left ankle, and MEB was initiated.  The MEB narrative summary (NARSUM) was dated 9 March 2005.  Physical examination (PE) of the left ankle revealed mild tenderness to palpation (TTP); but no edema (swelling), erythema (redness), ecchymosis (bruising), crepitus, ligamentous instability, or deformity.  Active range-of-motion (ROM) was measured, and is summarized in the chart below.  The NARSUM examiner’s diagnosis was: “Left ankle pain, status post peroneal retinacular reconstruction.”

Seven months after separation, on 1 April 2006, he had a VA Compensation and Pension exam.  He reported pain, popping, and swelling of the left ankle.  Symptoms were made worse by prolonged standing, prolonged walking, or any attempt at running.  He was using a cane about 1-2 days per month, due to the left ankle pain.  PE of the left ankle revealed some TTP; but no painful arc of motion, no ligamentous instability, no neurological deficit, and no gross deformity.  The ROM evaluations in evidence which the Board weighed in arriving at its recommendation are summarized in the chart below.

Left Ankle ROM
(Degrees)	MEB ~5½ mos. Pre-Sep
(20050309)	VA C&P ~7 mos. Post-Sep
(20060401)	
Dorsiflexion (20 Normal)	0	15	
Plantar Flexion (45)	20	25	
Comment	“marked” limitation	“moderate” limitation	
§4.71a Rating	20%	10%	

The Board directed attention to its rating recommendation.  The March 2005 MEB exam was closer to the DOS, and therefore carried greater probative value.  At that exam, there was 0 degrees dorsiflexion and 20 degrees plantar flexion.  The CI’s limitation of ankle motion at that time was best described as “marked.”  IAW VASRD §4.71a, a 20% rating is warranted when the limitation of ankle motion is “marked.”  The Board tried to find a path to a higher rating for the left ankle.  Using the VASRD §4.71a diagnostic codes for the ankle (5270 through 5274); a higher rating of 30% would require ankylosis (frozen joint).  From the evidence in the record, the CI clearly did not have ankylosis.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the unfitting left 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 unfitting left 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 20140625, 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
25118TH 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

JUL 182016

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160004393 (PD201403150)

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