RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00635
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080515

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

CI CONTENTION:  The CI requests consideration 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 - 20080924	VARD - 20080926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5271	10%	Left Ankle Fracture	5271	0%	STR	
Hearing Loss	Not Unfitting	No VA Placement	
Obesity	
Not Ratable
		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Ankle Pain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle pain condition began in March 2006 after playing volleyball while deployed.  Initial X-rays were normal; however, despite a profile, he continued training and his duties.  In May 2006 the CI was diagnosed with a left ankle sprain of the tibiofibular ligament with expectation of complete resolution.  X-rays of the left ankle in August 2006 were normal.  Magnetic resonance imaging in February 2007, ordered for persistent pain to the left ankle for a year, demonstrated osteochondritis dissecans (OCD) (a portion of bone that lost blood supply) measuring 1 cm at the medial aspect of the dome of the talus, with a stable fragment, a split-tear of the peroneus brevis at and distal to the lateral malleolus, synovitis (inflammation) in the ankle mortise, and deep retrocalcaneal bursitis (inflammation of fluid collection).  In April 2007 magnetic resonance imaging (MRI) showed a talus fracture.  He underwent a left ankle medial osteotomy of the osteochondral lesion of the talus (OLT) with a synthetic graft placement in April 2007.  Post-surgical changes of the medial malleolus were noted without any complications on X-rays and a minimal synovitis joint effusion at the ankle mortise.  An MRI in June 2007 demonstrated osteochondral reconstruction with chronic tears of the anterior talofibular and calcaneofibular ligaments and a partial tear of the posterior talofibular ligament with synovitis, joint effusion and posterior synovitis consistent with posterior impingement.  In August 2007 the CI received an ankle orthosis (for ankle support).  An MRI in November 2007 showed stable findings within the medial talar dome and in the region of the OCD reconstruction with bone marrow edema within the media talus.  By December the CI reported the left medial ankle pain was starting to improve slowly with physical therapy.  As a result, he was able to do just about all duties except running; however, he had pain climbing stairs.  At the orthopedic examination on 17 December 2007, 5 months before separation, the examiner reported full range of motion (ROM) with pain elicited by terminal dorsiflexion.  

At the MEB examination (recorded on DD Forms 2807-1 and 2808) dated 9 January 2008, 4 months prior to separation, the CI reported ankle surgery performed April 2007.  Physical examination revealed a scar of the left ankle.  Both extremities and feet were checked normal on the clinical examination.  At the NARSUM examination on 17 January 2008 he was tender to palpation in the anterior crease of his ankle directly over his talus; otherwise the ankle examination was stable to varus and valgus stress and there was no anterior drawer or talar tilt observed.  Neurologic evaluation was unremarkable and muscular strength was 5/5.  The ROM was 2 degrees dorsiflexion (20 normal) and 40 degrees plantar flexion (normal 40).  The CI had scar tissue and capsular stiffness limited movement; estimated 15 degrees loss of ROM due to mechanical factors and pain limited ROM.  The examiner’s diagnosis was chronic left ankle pain, secondary to talus fracture.  

The CI underwent a VA C&P examination on 31 July 2008, 14 months after separation, at which time he reported a chronic low level of discomfort in his left ankle, 2/10 (10 being the worst pain), although he was working full time with a limitation of running except in emergency.  The CI had an increase in pain two to three times a week due to position and activity.  On examination he walked without a limp and was able to walk on his heels and toes.  He had a normal shoe wear pattern without breakdown and had no callosities to indicate abnormal weight bearing.  He had a 12 cm well healed surgical scar over the medial malleolus of the left ankle.  Both ankles dorsiflexed to 15 degrees and plantar flexed to 45 degrees with three repetitions.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5271 code (Ankle, limited motion of), citing limitation of dorsiflexion to 4 degrees with normal plantar flexion.  The VA assigned a 0% rating using the 5271 code (Ankle, limited motion of) based on the VA C&P examination 14 months after separation, citing “a noncompensable evaluation is assigned unless there is moderate limited motion of the ankle.”  The Board considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  The Board majority agreed that the ROM examination most proximate to separation was more precise than prior examinations and was consistent with a marked limitation of motion for a 20% rating under this code, since dorsiflexion was decreased to 2 degrees and plantar flexion to 40 degrees, which was noted to be due to scar tissue and capsular tightness.  Furthermore, MRI findings proximate to separation showing chronic tears of ligaments of the ankle, although there was no laxity, lend credence to the decreased ROM measurements.  In the absence of ankylosis (5270 code) or a severe foot injury (5284 code) a higher rating is not applicable.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 20% for the left ankle pain condition, coded 5271. 

Contended PEB Conditions:  Hearing Loss and Obesity.  The Board’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 Board 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.  Furthermore, obesity is not a physical disability and is not ratable.

BOARD FINDINGS:  In the matter of the left ankle pain condition, the Board majority recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  The single voter for dissent recommended no change to the assigned rating and did not elect to submit a minority opinion.  In the matter of the contended hearing loss and obesity conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Ankle Pain	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150605, 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, AR20170000311 (PD201500635)

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 20% 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