RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04087
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090527

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

CI CONTENTION:  The CI 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 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 - 20090219	VARD - 20090803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain ...	5271	20%	Surgical Residuals, Left Ankle 	5271-5003	10%	20090408	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered a sports injury to his left ankle in October 2006.  He was diagnosed with a ligamental injury (partial tear of the anterior tibiofibular ligament with intact syndesmosis [fibrous joint]).  A trial of conservative treatment was ultimately unsuccessful.  An MEB was initiated and the NARSUM completed prior to a decision for surgery (arthroscopic synovectomy, debridement and ligament repair) which was performed on 16 January 2009, 4 months prior to separation.  Surgical results were insufficient for a return to unrestricted duty, and the MEB forwarded “chronic left ankle pain” to the PEB.

The MEB NARSUM on 20 October 2008, 3 months prior to surgery and 7 months prior to separation, documented persistent pain interfering with running and load bearing.  The physical examination recorded tenderness and range of motion (ROM) measurements of dorsiflexion (DF) averaging minus 10 degrees (normal 20) and plantar flexion (PF) averaging 35 degrees (normal 45).  Measurements a few weeks later in the orthopedic clinic were DF minus 10 degrees and PF 45 degrees.  The only post-operative evidence from the STR was from an orthopedic note in February 2009, 3 months prior to separation, that documented “doing well ... no limitations in motion; good strength.”  There was no post-operative STR evidence for gait disturbance, more significant ROM limitation, joint instability, or severe functional impairment.

The VA Compensation and Pension (C&P) examination on 8 April 2009, 7 weeks prior to separation, documented the CI’s report of “minimal improvement of his [ROM]” and constant pain with subjective weakness, but no subjective instability or locking.  Frequent flares of pain (3/week lasting 30 minutes) were reported which were precipitated by “extensive walking or standing;” however, the examiner noted that he was “able to do his usual occupation.”  The physical examination recorded a normal gait without assistive device, absence of tenderness or swelling, and ROM measurements of DF 10 (positive) degrees and PF 30 degrees, specifying painful motion.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 20% rating under code 5271 (limited motion of the ankle), which is the maximum rating under that code for “marked” limitation.  The VA assigned a 10% rating under code 5271-5003 (degenerative arthritis) based on the pre-separation C&P examination, citing limited and painful motion.  There was no ankylosis, nonunion or malunion to support a rating higher than the PEB’s 20% under any alternate joint code.  The Board considered analogous functional-based rating under 5284 (foot injuries, other), but members agreed that the evidence did not support the presence of “severe” disability necessary for a rating higher than 20%.  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 left ankle condition.    

BOARD FINDINGS:  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 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear 

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-04087.

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