RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00594
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030819

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Multiple Launch Rocket Systems Fire Control Specialist, medically separated for “chronic pain…left ankle” with a disability rating of 0%.  

CI CONTENTION:  The applicant contends his injury affects his current activities and has caused a limp and a lower back condition.  His complete submission, with attachments, 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:  

IPEB - 20030807	VARD - 20030906	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, S/P ORIF of Fracture, Left Ankle	5099-5003	0%	Fracture, Left Ankle…	5271	10%	20030708	
			Scar, Left Ankle…	7805	0%	20030708	
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Ankle Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began when he suffered a fracture in a twisting injury on 6 January 2003 during basic training.  Radiographic studies showed a left ankle fracture which was successfully treated with surgery on 14 January 2003.  Post-operatively, the CI was treated with physical therapy and had what was characterized as “excellent radiographic and clinical healing,” but continued to report a painful ankle.  

At the time of the orthopedic appointment on 28 May 2003 (3 months prior to separation), all clinical findings were normal, with no swelling, full strength, and good pulses in ankle arteries.  The examiner characterized the January ankle surgery as having a “very good result,” and gait was reported as normal when observed in boots.  Despite treatment, the CI’s ankle condition could not be adequately rehabilitated to meet the physical requirements of his military specialty, so he was referred for MEB.  

At the MEB NARSUM examination performed 18 June 2003 (2 months prior to separation), the CI reported what the examiner characterized as subjective pain that did not correlate with clinical findings.  Physical examination revealed no swelling and well-healed, non-tender surgical scars.  The CI was observed as displaying “exquisite wincing and flinching that is not in correlation with light touch on examination and disappears with distraction.”  The rest of the examination was normal, though the examiner again noted the CI overreacted to mild stimuli.  Radiographs revealed “excellent alignment of fracture.”  ROM was reported as depicted in the chart below.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 19 June 2003 (the day after the NARSUM examination), the CI reported his ankle injury and subsequent surgery, and indicated he suffered from intermittent swelling.  Physical examination showed ROM as reported in the chart below (notably different than the day prior) and persistent left ankle pain was noted.  

At the VA Compensation and Pension (C&P) examination on 8 July 2003 (1 month prior to separation), the CI reported left ankle stiffness and soreness, lasting 1 hour, occurring three times per week.  He also reported soreness in the surgical scar with movement.  The CI denied lost work time and indicated the condition did not interfere with activities of daily living.  Physical examination showed normal surgical scars with no limitation of motion from the scars.  Posture was normal, but an abnormal gait (limping) was observed.  Further examination results are depicted in the chart below.  

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.  

Left Ankle ROM
(Degrees)	Ortho ~3 Mo. Pre-Sep	NARSUM ~2 Mo Pre-Sep	MEB ~2 Mo. Pre-Sep	VA ~1 Mo. Pre-Sep	
Dorsiflexion (20 Normal)	10	15	0	16	
Plantar Flexion (45)	25	25	30	34	
Comment	Normal gait; subjective pain	Neurovascularly intact		Painful motion; limping type gait	
§4.71a Rating	10%	10%	10-20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5099-5003 code (analogous to arthritis), citing use of the USAPDA Pain Policy.  The VA assigned a 10% rating using the 5271 code (limitation of motion of the ankle), based on the VA C&P examination 1 month before separation, citing painful and limited motion.  The Board agreed that the ROM examinations proximate to separation detailed above were consistent with a moderate limitation of motion (supported by the presence of swelling as reported by the CI and an abnormal gait as reported in the VA C&P exam) for the 10% rating, coded 5271.  All Board members agreed the limitation of motion was no more than moderate and therefore a higher rating of 20% was not indicated in the absence of marked limited ROM of the ankle.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  Any contribution of the surgical scars to the ankle ROMs was considered in the ankle rating.  The CI did not have any restrictions on wear of military footgear.  There was no performance based evidence from the record that the ankle scars significantly interfered with satisfactory duty performance.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% 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 10%, 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Pain, s/p ORIF of Fracture, Left Ankle	5271	10%	
RATING	10%	

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

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 AR20160014885 (PD201500594)

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 10% 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