RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-04190
BRANCH OF SERVICE:  Army                                                             Date of seperation:  20040323

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Human Resources Specialist, medically separated for “chronic pain right ankle,” with a disability rating of 10%.    

CI CONTENTION: “Please 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 - 20040107	VARD - 20040413	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Ankle	5099-5003	10%	Surgical Residuals, Right Ankle 	5299-5271	10%	20040206	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Ankle Condition.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a sprain injury (inversion) to the right ankle in August 2002.  Imaging (CT) demonstrated a “small” osteochondral defect of the talar dome (defect in the smooth articular surface of the major weight-bearing joint).  There was no evidence of any ligamental or other soft tissue injuries and the joint remained stable to examination.  The outpatient STR evidence probative to functional impairment, range of motion (ROM), and other VASRD rating criteria was consistent with that from the NARSUM and VA examinations which follow.  Surgery was not recommended; conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for MEB which in turn forwarded “chronic ankle strain” and “osteochondral defect talar dome” to the PEB.  

The NARSUM examination on 1 December 2003 (4 months before separation) documented “ongoing pain ... [rated as] ... moderate and constant, rising to severe at times” that did not interfere with administrative duties, but limited walking (1/2 mile) and prohibited running and load bearing.  The physical examination recorded tenderness and stability to stress testing.  Measured ROM was dorsiflexion to 10 degrees (normal 20) and plantar flexion to 45 degrees (normal). 

A VA Compensation and Pension (C&P) examination on 6 February 2004 (7 weeks before separation) documented constant pain rated 8/10 aggravated by prolonged walking or standing.  The physical examination recorded a normal gait, tenderness, lateral swelling, and “no joint laxity.”  Measured ROM was dorsiflexion to 10 degrees and plantar flexion was “normal,” specifying painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) referenced the U. S. Army Physical Disability Agency (USAPDA) pain policy, but was compliant with VASRD §4.71a criteria for the MEB findings and ROM evidence.  The VA assigned a 10% rating under code 5271 (limited motion of the ankle), citing moderate ROM limitation based on the C&P findings.  The Board considered if the ROM limitation could be fairly characterized as “marked” in support of a 20% rating under 5271, but members agreed that the ROM evidence (50% reduction in dorsiflexion, otherwise normal) was consistent with moderate limitation and that rating under 5271 would not be advantageous.  Given the absence of ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than 10% for this case.  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 of 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 20140227, 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

07 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018265 (PD201404190)

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