RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00177
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, (Shower/Laundry/Clothing Specialist), medically separated for “posttraumatic arthritis of the left ankle” with a disability rating of 10%.

CI’s CONTENTION:  The CI wrote “I still have the same issues, and was rated lower than I should have been.  I was thrown a 10% rating and pushed out the door.  I believe it wasn’t fully looked over.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’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 panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determinations is based on 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 panel 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 panel 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 - 20080620	VARD - 20090116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthritis of the Left Ankle…	5010	10%	Left Ankle Sprain	5271	0%	20081205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Ankle Arthritis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in April 2007, following an inversion injury during a training run.  Radiographic studies 28 March 2008 showed no evidence of acute fracture, dislocation or joint effusion.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “chronic ligamentous instability of the left ankle,” and “post-traumatic arthritis of left ankle” for PEB adjudication.  

At the MEB NARSUM examination on 5 June 2008, 3 months prior to separation, the CI reported constant left ankle pain with stiffness and weakness, which was worse in the morning and following activities, and with symptomatic flare-ups five times per week.  He noted popping, especially with stairclimbing, easy fatigability, weakness, instability, lack of endurance and episodes of incoordination in his left ankle.  The MEB physical examination noted a moderately antalgic gait, some instability, and painful motion with eversion, inversion, dorsiflexion to 22 degrees (normal 20) and plantar flexion to 26 degrees (normal 45 degrees).  

At the 5 December 2008 VA Compensation and Pension (C&P) examination, performed 4 months after separation, the CI reported left foot pain.  Physical examination showed a normal gait and the plantar flexion limited to 40 degrees without painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5010 (arthritis, due to trauma, substantiated by X-ray findings), citing posttraumatic arthritis with satisfactory evidence of painful joint motion.  The VA rated the ankle condition 0%, coded 5271, (limited motion of the ankle), citing a non-compensable evaluation based on findings at the VA examination which showed no painful or limited motion.  The right ankle limitation of motion recorded at the time of the MEB NARSUM examination was mild.  However, there was painful motion and ligamentous laxity supporting a 10% rating for painful motion IAW §4.59 (Painful motion).  All members agreed the limitation of motion was not marked to support a 20% rating under 5271.  The panel also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7), however all panel members agreed that the impairment did rise to the level of moderately severe to support 20% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel found insufficient cause to recommend a change in the PEB adjudication for the left ankle condition.  

Contended PEB Conditions:  Bilateral Tinnitus, Flat Foot Deformity, and Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral tinnitus, flat foot deformity, and headache conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150223, 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

10 Apr 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170004980 (PD-2015-00177)

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