RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00577
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20020703

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

CI CONTENTION:  The CI contends for a review of 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 - 20020515	VARD - 20021202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5299-5003	10%	Recurrent Right Ankle Sprains	5299-5271	0%	20021001	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced persistent right ankle pain following a sports injury in January 2000.  He underwent reconstructive surgery (Broström procedure) in February 2001 at which time chondromalacia (damaged joint cartilage) and synovitis (inflammation of joint capsule) were identified.  The CI underwent a second procedure (arthroscopic debridement for impingement) in January 2002 (6 months prior to separation) which still did not result in improvement sufficient to allow unrestricted duty.  Range of motion (ROM) measurements by physical therapy (PT) were conducted for the MEB on 25 February 2002 and are charted below.  There were no STR entries (after rehabilitation) indicating more significant ROM limitation, joint instability, severe functional limitations, periods of incapacitation after surgical recovery, or other ratable evidence.  The MEB forwarded “right ankle severe chondromalacia…grade II chondromalacia of the talar dome and tibia…large amount of synovitis in the anterior portion of the ankle joint” to the Physical Evaluation Board (PEB) for adjudication.

At the NARSUM examination on 3 May 2002, the CI reported constant pain and swelling, aggravated by prolonged standing (10-15 minute tolerance) and walking (one mile tolerance).  The physical examination recorded swelling and tenderness, normal strength and sensation, and the ROM measurements charted below.  

At the VA Compensation and Pension (C&P) examination on 1 October 2002, performed 3 months after separation, the CI reported he could no longer run and had trouble walking long distances.  The physical examination recorded a normal gait, “a small degree of swelling,” ligamentous stability, and “full” ROM as charted below.  

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation are summarized in the chart below.  

Right Ankle ROM (Degrees)	PT ~5 Mos. Pre-Sep	MEB ~2 Mos. Pre-Sep	VA C&P ~3 Mos. Post-Sep	
Dorsiflexion (20 Normal)	5	5	“Full Motion”	
Plantar Flexion (45)	45	45		
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating analogous to code 5003 (arthritis, degenerative), citing limited dorsiflexion of 5 degrees and no ankle instability.  The VA assigned a 0% rating analogous to code 5271 (ankle, limited motion of) based on the VA C&P examination, citing full motion.  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 examinations proximate to separation were consistent with moderate limitation and rating under 5271 would not be advantageous.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than 10%.  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 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 20150603, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017820 (PD201500577)

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