RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00465
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Munitions Systems Journeyman, medically separated for “moderate right ankle pain following ligament surgery” with a disability rating of 10%.

CI CONTENTION:  “Review 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 - 20051104	VARD - 20060608	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Moderate Right Ankle Pain following Ligament Surgery	5271	10%	Residuals, Status Postoperative Right Ankle Surgery, Reconstruction of Lateral Ligament	5271	10%	20060503	
Overweight	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle pain condition began in February 2003 while playing basketball at a deployed location.  The CI underwent reconstruction of the lateral collateral ligament of the right ankle using a peroneus brevis transfer in September 2003. Postoperatively, pain persisted.  Magnetic resonance imaging in August 2004 revealed a torn ATFL (anterior tibiofibular ligament) with edema, which was interpreted by an orthopedic surgeon as showing an osteochondral lesion (an injury or fracture of the cartilage) of the talar dome with some bone marrow edema.  Right ankle X-rays showed post-surgical changes but no acute injury.   Computerized tomography (CT) revealed a small OCD (osteochondritis dissecans) lesion (of the cartilage and bone due to necrosis and loss of continuity of the underlying bone) of the anterior talar dome.  In April 2005 the CI underwent right ankle arthroscopy with debridement of hypertrophic synovium (membranous covering of a joint) and frayed cartilage and drilling in the area of the talar dome where the OCD lesion was located.  Following surgery further treatment including physical therapy did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right ankle pain” for PEB adjudication.

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

Right Ankle ROM
(Degrees)	PCC ~3 Mos. Pre-Sep	MEB ~2 Mos. Pre-Sep	VA C&P ~4 Mos. Post-Sep	
Dorsiflexion (20 Normal)	“Limited ROM in flexion/dorsiflexion/side movements”
	“Range of motion is limited in flexion, dorsiflexion, and laterally”
	15	
Plantar Flexion (45)			35	
Comments	-	-	Painful motion; abnormal gait; tenderness; mild edema	
§4.71a Rating	10%	10%	10%	

The MEB NARSUM on 9 October 2005, 2 months prior to separation, noted the CI underwent two ankle surgeries and reached his maximum improvement with no other surgical options.  The physical examination showed well-healed scars of the right foot and ankle with mild tenderness.  The CI’s ROM was limited in both flexion and dorsiflexion with some decreased sensation surrounding the surgical wounds.

At the 3 May 2006 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported constant right ankle pain at 5/10.  The CI also used an ankle brace.  The physical exam showed a positive antalgic gait and limited ROM.  The CI had mild edema, hyperpigmented scars and no evidence of ecchymosis or erythema.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the moderate right ankle pain condition 10%, coded 5271 (ankle, limited motion).  The VA rated the moderate right ankle pain condition 10%, coded 5271 (ankle, limited motion of), based on the VA C&P examination 4 months  after separation, citing dorsiflexion to 15 degrees, plantar flexion to 35 degrees, mild edema, tenderness and a positive antalgic gait.  The Board concurred that a 10% rating for functional loss (§4.40, §4.45, §4.59) due to instability and pain was appropriate as adjudicated by the PEB.  The Board considered alternative VASRD ankle codes 5270 (ankle ankylosis), 5272 (subastragalar or tarsal joint ankylosis), 5273 (os calcis or astragalus malunion) and 5274 (astragalectomy) and analogous codes, but all were less applicable including code 5271 (marked ankle limited motion) based on the VA examination of ankle ROM, albeit 4 months after separation, since pre-separation ROMs were noted to be “limited,” but lacked objective measurements.  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 moderate right ankle pain condition.  

Contended PEB Condition-Overweight.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  Overweight does not constitute a physical disability.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the moderate right ankle pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended overweight condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20150601, 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 XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00465.

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