RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00590
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071012

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Air and Missile Defense Crewmember, medically separated for “right ankle pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI’s condition continues to worsen, as well as her back, hips and knees.  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 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 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 - 20070924	VARD - 20120706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain, Right Ankle, after Fracture from a Fall…	5099-5003	10%	Right Ankle Fracture	5271	NSC	No Show	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Right Ankle Fracture.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI dislocated and fractured her ankle after falling from an obstacle on the physical endurance course in March 2007 during basic training.  She subsequently underwent an open reduction, internal fixation (ORIF) surgery.  Radiographic studies in July 2007 documented soft tissue swelling and anatomic alignment of healed medial and lateral malleolar fractures with hardware in place.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right ankle pain secondary to a fracture” for PEB adjudication.  

At the 19 July 2007 orthopedic examination (3 months before separation), dorsiflexion was to 10 degrees (normal 20) and plantar flexion was to 35 degrees (normal 45).  At the MEB NARSUM examination on 27 August 2007 (2 months before separation), the CI reported pain that was worse after prolonged walking.  The physical examination noted a well-healed surgical scar, and mild tenderness over the lateral ankle.  Dorsiflexion was to 5 degrees and plantar flexion was to 34 degrees.  

The CI failed to report to the scheduled 31 August 2011 VA Compensation and Pension (C&P) examination.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded analogously to 5003 (arthritis, degenerative), citing slight/frequent pain in accordance with the US Army Physical Disability Agency pain policy.  The VA did not service connect the right ankle condition, but coded it 5271 (limited motion of the ankle), and cited no current evidence of a chronic right ankle disability associated with the in-service injury.  There was no limitation of dorsiflexion or plantar flexion that supported a higher rating for “marked” limitation of motion (5271).  The Board agreed that the ROM examinations proximate to separation detailed above were consistent with a moderate limitation of motion and there was evidence of painful motion causing functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  The Board did not find evidence that a tender or painful scar separately interfered with duty and therefore a separate rating was not recommended for unfitting scar.  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 20150602, 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 XXXXXXXXXXXXXXXXXXXXX, AR20170000271 (PD201500590)

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