RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03926
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080506

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Fire Support Specialist, medically separated for “chronic right ankle pain,” with a disability rating of 10%.  

CI CONTENTION:  The applicant requests the Board consider all conditions.  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 - 20080303	VARD - 20080425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5099-5003	10%	Right Ankle S/P Broström Repair	5271	0%	20070927	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right ankle surgery (Broström procedure) in February 2007 for ligament repair.  At the time of the podiatry clinic appointment on 31 July 2007, 9 months before separation and 5 months after surgery, the examiner recorded that the CI was “ambulating in regular boots.”  The CI reported pain and stiffness in his right ankle.  On examination there was decreased range of motion (ROM) and weakness, but no tenderness to palpation or painful motion.  At the time of the physical therapy clinic appointment on 15 August 2007, 8 months before separation and 6 months after surgery, the examiner recorded increased right ankle pain and difficulty with stairs.  On examination there was an antalgic gait, increased pronation bilaterally, and pain with heel and toe walking.  There was minimal right ankle swelling and tenderness to palpation.  The ROM was within normal limits, but there was pain with resisted dorsiflexion.  He had normal strength.  He had a positive bilateral talar tilt.  Anterior drawer test for ligamentous instability was negative.  Despite treatment, the CI’s ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB. 

At the VA Compensation and Pension (C&P) examination on 27 September 2007, performed 7 months before separation, the CI reported pain, swelling, and decreased ROM.  Aggravating factors were exercise, prolonged standing, climbing activities, and climbing stairs.  The physical examination was significant for mild right ankle tenderness to palpation with normal gait and strength. There was no swelling, limitation of motion, or ligamentous instability.  

Physical findings at the time of the physical therapy ROM examination on 10 October 2007, 7 months before separation, were decreased dorsiflexion and painful motion.  At the MEB NARSUM examination on 14 November 2007, 6 months before separation, the CI reported persistent right ankle pain, swelling, and some limitation of motion.  He reported that the pain was exacerbated by exercise or prolonged standing.  On examination there was mild residual edema (swelling) over a well healed scar and mild ankle tenderness to palpation.  There was no crepitus and ankle strength was normal.  The right ankle ligaments were stable without “significant discomfort.”  The 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)	VA C&P~7 Mo. Pre-Sep
	PT~7 Mo. Pre-Sep
	NARSUM~6 Mo. Pre-Sep
	
Dorsiflexion (20 Normal)	20	15/15/20	20	
Plantar Flexion (45)	45	60/60/60	45	
Comment			Mild swelling	
§4.71a Rating	0%	10%	0%	

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 painful motion and no limitation of motion.  The VA rated the right ankle condition 0% coded 5271 (limited motion of the ankle), citing normal ROM without evidence of additional functional loss.  There was no limitation of dorsiflexion or plantar flexion that supported a minimum rating under the VASRD diagnostic code for limitation of motion (5271);  however, there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45).  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to 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 20140908, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

28 JUL 2016

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 (PD201403926)

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