RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03412
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Security Forces Craftsman, medically separated for “chronic right ankle pain” and “chronic left ankle pain,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The applicant was given a higher rating for his conditions by the VA.  The CI’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 - 20071001	VARD – 20080918	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	Status Post Right Ankle Reconstruction with Surgical Scar	5271	10%	20080221	
Chronic Left Ankle Pain	5311	10%	Status Post Left Ankle Reconstruction with Surgical Scar	5271	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right and Left Ankle Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right ankle surgery in October 2005 for lateral ligament primary repair and left ankle surgery in June 2006 to repair a tear of the anterior talofibular ligament.  Following these surgeries further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “bilateral ankle pain and instability” for PEB adjudication.

At the MEB NARSUM exam, performed 3 months prior to separation, the CI reported that he continued to have bilateral ankle pain with instability and also continued to “roll both of his ankles.”   He also reported that it was “quite painful… to be on his feet most of the day.”  The MEB physical exam documented right and left ankle dorsiflexion of 15 degrees (NL=20) and plantar flexion at 30 degrees (NL=45).   Painful motion in either ankle was not identified.  His gait was normal.  The examiner documented negative drawer (ankle instability) test in the right ankle; however, left ankle anterior drawer test was approximately 1 cm, therefore, positive.  In addition, there was slightly more laxity with hind foot inversion on the left than the right.    Sensory, motor, and vascular function was intact throughout the foot.  Radiographs of bilateral ankles taken 9 months prior to separation were unremarkable without fracture, dislocation or arthritic abnormalities.  Magnetic resonance imaging demonstrated the lateral ligament repair of both ankles were intact.  

At the VA Compensation and Pension (C&P) examination on 21 February 2008, performed 3 months after separation, the CI reported “increased pain with rolling of the bilateral ankles, left greater than right.”  He also reported that he had “instability of the left greater than right ankle.”  Physical exam showed normal gait.  Examination of the right ankle recorded pain with inversion, and absence of laxity.  ROM documented dorsiflexion of 5 degrees, and plantar flexion at 20 degrees.  Left ankle ROM recorded dorsiflexion of 5 degrees with pain, and plantar flexion of 25 degrees with pain.   Mild laxity of 5mm was noted during anterior drawer test, and there was “instability noted with a grinding sensation and significant pain…with inversion.”  There was no left ankle laxity with eversion.  Surgical scars on both ankles were non tender. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10% (coded 5099-5003, analogous to degenerative arthritis), citing mild decreased ROM.  The PEB rated the left ankle condition 10% (coded 5311, muscle group XI), citing slight hind foot laxity.  The VA rated the right ankle condition 10% (coded 5271, limited motion of the ankle), citing moderate limitation of motion.  The VA also rated the left ankle condition 10% (coded 5271), citing moderate limitation of motion.

The Board considered if the limitation of motion was moderate or marked when considered under code 5271, limitation of ankle motion.  The Board agreed that the ROM examinations proximate to separation detailed above were consistent with a moderate limitation of motion for the 10% rating under this code.   All Board members agreed the 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 ankles.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  The Board also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7) however all Board members agreed that the impairment did not more nearly approximate moderately severe to support a higher 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 right or left ankle conditions.

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the 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.  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 20140413, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03412.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings