RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03457
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated for “right ankle instability and pain,” with a disability rating of 10%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively impact his daily activities.   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 based upon a 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 – 20060309	VARD – 20061108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Instability and Pain	5271	10%	Right Peroneal Tendon Subluxation	5271	10%	20060815	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Ankle Instability, and Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this CI’s right ankle condition began in May 2002 after a rappelling injury during mountain training.  Magnetic resonance imaging (MRI) in January 2003 showed posterior impingement syndrome, with bone marrow edema.  The tendons and remaining bony and cartilaginous structures were normal.  Between April 2003 and November 2004, the CI had four surgical procedures on his right ankle.  In spite of all treatment efforts, he continued to have significant problems with his right ankle, and MEB was initiated.  The MEB forwarded “status/post multiple surgeries, right ankle, for ankle stabilization” and “significant ankle range of motion restrictions” for PEB adjudication.

The range of motion (ROM) evaluations in evidence which the Board weighed in arriving at its recommendation, are summarized in the chart below.

Right Ankle ROM
(Degrees)	PT ~7 Mo. Pre-Sep
(20051104)	VA C&P ~2 Mo. Post-Sep
(20060815)	
Dorsiflexion (20 Normal)	10	20	
Plantar Flexion (45)	45	45	
Comments	Painful motion	Painful motion	

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 14 September 2005, 9 months prior to separation, the CI reported right ankle pain.  The pain was aggravated by running greater than 4 miles, and lifting.  Physical examination showed moderate heel swelling, and tenderness to palpation over the right lateral Achilles tendon.  At the VA Compensation and Pension (C&P) examination on 15 August 2006, performed 2 months after separation, the CI reported constant right ankle pain radiating to his Achilles tendon.  The pain was described as squeezing, burning, aching, sharp, and sticking.  The pain was aggravated by physical activity, and was relieved by rest, medications, icing, and elevation.  Physical examination showed tenderness, with no signs of deformity.  Ankle ROM was normal, but ankle motion was painful.  X-rays of the ankle showed no evidence of fracture or subluxation.  

The Board directed attention to its rating recommendation based on the evidence.  The PEB used VASRD code 5271 (limited motion of the ankle), and rated the right ankle condition 10%, citing limitation of motion.  The VA also rated the right ankle condition 10%, coded 5271, citing decreased range of motion due to pain.  The Board carefully reviewed the data from the ankle examinations described above.  The August 2006 C&P examination was just 8 weeks after separation, and therefore had significant probative value.  At that examination, ankle ROM was normal; however, IAW VASRD §4.10 (functional impairment), §4.40 (functional loss), §4.45 (joints), and §4.59 (painful motion), when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional loss and disability due to pain.  There was no path to a higher rating for the right ankle, since there was insufficient evidence of a seriously disabling bone or joint abnormality which would justify a higher rating.  After due deliberation, the Board determined that a disability rating of 10% for the right ankle was appropriate.  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 right ankle condition.    

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.10, §4.40, §4.45, and §4.59; 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 20140526, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20160011344 (PD201403457)

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