RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00036
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050725

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Satellite Communicator, medically separated for “chronic left ankle pain,” with a disability rating of 0%.  

CI CONTENTION:  He required five surgeries for his ankle and also contended two other conditions not identified by the MEB or PEB.  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 - 20050602	VARD – 20060228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5009-5003	0%	Left Ankle Strain	5299-5271	10%	20061118	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Left Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left ankle playing football in August 2002.  He was treated with both casting and physical therapy (PT), but required surgical debridement which was accomplished in December 2003.  Rehabilitative PT did not resolve the pain and a post-operative MRI revealed an osteochondral lesion (defect of the cartilage lining one of the bones in the ankle joint) of the medial talar dome.  The CI was offered a second surgery but declined preferring conservative therapy.  At an orthopedics examination on 9 November 2004, 9 months before separation, he reported ongoing pain, but reduced subjective instability.  During a physical therapy examination on 25 February 2005, 5 months before separation, he again reported continued left ankle pain.  Left ankle range of motion (ROM) measurements are documented in the chart below.  Despite treatment, the left ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for a MEB.  The MEB forwarded “chronic ankle pain status post arthroscopy” for PEB adjudication.

At the MEB narrative summary (NARSUM) examination dated 3 May 2005, 3 months before separation, the CI complained of continued chronic daily left ankle pain exacerbated by repetitive motion exercises and going up and down stairs.  NARSUM history documented that the CI was able to walk and pass the Army physical fitness test in November 2004, but that he had not been able to accomplish the run portion since 2001.  The examination did not document gait, the use of assistance devices, or activities of daily living limitations.  The ankle was stable and the arch and Achilles tendon were normal.  

During the VA Compensation and Pension (C&P) joint examination on 16 November 2006, performed 6 months after separation, the CI reported continued left ankle pain with weakness, swelling and stiffness and that he walked with a limp.  He denied use of assistive devices, dislocation, or subluxation.  His activities of daily living were normal.  The examination did not specifically document the gait other than the self-report.  The ROM was painful and limited with dorsiflexion to 0 degrees and plantarflexion to 45 degrees.  There was no change with repetition.  Two days later, at the VA C&P general examination, the CI reported left ankle pain exacerbated by climbing stairs and prolonged walking or standing.  He denied incapacitation.  He currently used an ankle brace for support and walked with a limp.  His ankle could be easily rolled and gave way.  The examination revealed difficulty rising on heels or toes.  The ROM was painful and limited with dorsiflexion to 10 degrees and plantarflexion to 35 degrees.  There was no change with repetition.  

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Left Ankle ROM
(Degrees)	Ortho ~9 Mo. Pre-Sep	PT/MEB NARSUM ~5 Mo. Pre-Sep	VA C&P Joints
~6 Mo. Post-Sep	VA C&P General
~6 Mo. Post-Sep	
Dorsiflexion (20 Normal)	10	5	0	10	
Plantar Flexion (45)	55	40	45	35	
Comments	Painful motion not documented	Painful limited motion	After 3 repetitions; pain limited motion	After 3 repetitions; painful motion	
§4.71a Rating	10%	10%	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating coded 5099-5003 (analogous to arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA assigned a 10% rating coded 5099-5003 (analogous to arthritis, degenerative), based on the VA C&P general examination 6 months prior to separation citing limited ROM.  Board members agreed there was moderate limitation of dorsiflexion that supported a rating under code 5271 (limitation of motion).  Painful motion causing functional loss also supported a 10% rating IAW VASRD §4.59 (painful motion), §4.40 (functional loss), and §4.45 (the joints).  The Board noted that the CI was able to pass the walk portion of the AFPT and concluded that this was more consistent with a moderate vice a marked loss.  The Board considered whether a rating under code 5284 (other foot injuries) provided a higher rating (§4.7); however, all Board members agreed that the impairment did not more nearly approximate moderately severe to support a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the left ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Ankle Pain	5271	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150112, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160013794 (PD201500036)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA