RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03494
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080802

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Computer/Detection Systems Repairer, medically separated for “right ankle pain and instability” with a disability rating of 10%.  

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts his daily activities.  His 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 - Dated 20080423	VARD - 20081006  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain and Instability	5099-5003	10%	Chronic Instability, Right Ankle	5299-5271	10%	20080829	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Right Ankle Pain and Instability Condition.  The first record in evidence for the right ankle condition is a primary care clinic visit dated 25 September 2000.  The CI was evaluated for a right ankle sprain and treated with duty restrictions and allowed to wear a “shoe of comfort.”  Over the next few years, the CI was seen periodically for a recurrent sprain.  An MRI, dated 27 October 2003, recorded ligamentous thickening consistent with old injuries as well as a loose body in the ankle joint.  This was treated surgically on 17 March 2004.  Following surgery he underwent rehabilitation.  He had a stable ankle and was issued a permanent L2 profile allowing him to run at his own pace and distance.  He was also issued a brace.  The CI was seen several more times over the next 3 years, typically after increased use with subsequent pain, but overall seems to have done well with the duty limitations.  In early 2007, he was begun on ankle rehabilitation for instability even on level surfaces.  On 12 September 2007, he reported ongoing problems despite rehabilitation.  On examination his gait and range of motion (ROM) were normal, the ankle was stable, and no swelling was present.  An orthopedic appointment on 5 November 2007, noted reduced dorsi-flexion (toes up) and reduced strength of the peroneal muscles (part of the calf muscles).  At the MEB examination on 17 December 2007, 8 months prior to separation, the CI reported chronic right ankle problems.  The examiner noted that the ROM was reduced, the inside ankle bone was tender, and there was a sign of instability.  The narrative summary (NARSUM) noted that the gait was slightly abnormal secondary to pain.  The ROM was reduced as charted below and one test for laxity was positive.  The ankle ligaments were tender to palpation.  Mild swelling was present.  At the VA Compensation and Pension (C&P) examinations performed on 29 August 2008, 4 weeks after separation, the CI reported intermittent ankle pain, lateral (outside) instability, and pain.  Standing was limited to 30 minutes.  The ankle did not impair his occupation.  The general medical examination recorded a normal gait and a normal neurological examination.  The joint C&P examiner noted that the right ankle had some swelling and a slight limp.  The ankle, including bony processes and the ligaments, was non-tender.  An X-ray showed a bony irregularity consistent with an old injury.  

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 ~6 Mo. Pre-Sep	VA C&P ~1 Mo. Post-Sep	
Dorsiflexion (20 Normal)	14	15	
Plantar Flexion (45)	25	45 (55)	
Comment	Abnormal gait	Abnormal gait	
§4.71a Rating	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%, respectively coded 5099-5003 (analogous to degenerative arthritis) and 5299-5271 (analogous to limitation in motion).  The Board considered the evidence and found no route to 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 ankle condition.  

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.  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 20140616, 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, AR20160011355 (PD201403494)

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