RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00083
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050623

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

CI CONTENTION:  His conditions continue to worsen and negatively impact his daily activities.  The applicant’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 - 20050318	VARD -20050922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5099-5003	10%	Left Ankle Osteochondritis Dissecans	5271	20%	20050803	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left ankle surgery (Brostrom repair and ankle scope) in March 2004 for torn ligaments.  At the time of the orthopedic clinic appointments in March and April 2004, the examiner recorded post-op X-rays indicated good placement of hardware and that the incisions were well healed.  At the time of the orthopedic clinic appointment on 4 June 2004 the CI reported left ankle pain and swelling.  The examiner noted the left ankle X-ray was normal.  A magnetic resonance imaging (MRI) performed on 15 June 2004 indicated no evidence of tears of the tendons, deltoid or talocalcaneal ligaments.  During the orthopedic clinic appointment on 6 July 2004 the CI reported pain and swelling after walking which was resolved by rest and immobilization.  The examination indicated no pain on range of motion (ROM).  There was crepitus on ROM testing and a small effusion.  At the time of the orthopedic clinic appointment on 3 January 2005 the CI reported chronic ankle pain and the examination indicated tenderness to palpitation and 5/5 strength.  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.  

An MRI performed on 13 January 2005 revealed bone bruising of the lateral tibia.  There was abnormal bone signal and focal articular cartilage loss at the medial posterior talar dome and a small joint effusion was seen.  The impression was probable OCD (osteochondritis dissecans) as clinically suspected.”  

At the MEB NARSUM examination on 7 February 2005, performed 5 months before separation, the CI reported chronic ankle pain aggravated by activity.  The MEB physical examination noted the CI was wearing an immobilizer for ankle stability.  The ROM was recorded as “full range of motion, dorsiflexion 20 (20 normal), plantar flexion 50 degrees (45 normal).”  It is noted there was a hand written change of dorsiflexion to -10 degrees and plantar flexion to 35 degrees likely changed after the physical therapy (PT) examination performed on 9 February 2005.  The Achilles tendon was palpable without defects.  There was no ankle effusion or instability.  Gait was recorded as within normal limits and muscle strength was normal.  

During the PT appointment on 9 February 2005 the CI reported pain at 6-7/10 at rest.  The ROM was dorsiflexion of -10 degrees (20 normal) and plantar flexion of 35 degrees (45 normal) with pain at each end range.  

At the VA Compensation and Pension (C&P) examination on 3 August 2005, performed 1 month after separation, the CI reported left ankle pain all the time with stiffness, decreased mobility and occasional swelling.  He indicated the pain was worse with weight bearing and during rainy weather.  The physical examination showed the ROM at 5 degrees of dorsiflexion (20 degrees normal) through 30 degrees of plantar flexion (45 degrees normal) with pain exacerbated only at each extreme.  There was no swelling, the joint was stable and his gait was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10% (coded 5099-5003; degenerative arthritis), citing full ROM (slight/frequent) with application of the United States Army Physical Disability Agency pain policy.  The VA rated the left ankle condition 20% (coded 5271; limitation of motion, of the ankle), citing ROM limited to less than half of normal.  

There were inconsistencies with the NARSUM’s changed ROMs from the typed entry to the initialed correction and slight uncertainty on the PT ROMs for dorsiflexion; however, the VA examination was closest to the date of separation and also supported the more limited PT ROMs.  The Board agreed that the ROM examinations proximate to separation detailed above were consistent with a marked limitation of motion supported by the presence of occasional swelling required for the maximum 20% rating under this code.  The Board also considered whether a higher rating was supported under other diagnostic code options.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 20% providing no benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% 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 20%, 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	
Chronic Left Ankle Pain	5271	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150121, 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 AR20160013799 (PD201500083)

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 20% 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