RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00768
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071028

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Watercraft Operator, medically separated for “chronic left ankle pain”  with a disability rating of 0%.  

CI CONTENTION:  The CI contends for his unfitting ankle condition.  The applicant’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 confined to 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 - 20070914	VARD - No VA Claim Filed	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5099-5003	0%	No VA Claim Filed	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI a history of recurring left ankle pain since a twisting injury in Basic Training, with the CI stating that he suffered an ankle fracture prior to entering the military.  Review of the Service entry MEB H&P DD Form 2808 (entrance physical examination) and DD Form 2807 conducted in March 2007 did not provide any information as to the ankle fracture suffered prior to enlistment.  Diagnostic imaging (X-ray, MRI and bone scan) indicated post-traumatic changes of the distal fibula consistent with a history of old fracture (lateral malleolus).  Roughening (degeneration) was seen over the medial talus.  There was no surgical indication, and conservative treatment with physical therapy and nonsteroidal anti-inflammatory medicines did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left ankle pain/instability” for PEB adjudication.  

Physical therapy range of motion (ROM) formal testing (for the MEB) dated 20 March 2007, 8 months prior to separation, documented pain limited dorsiflexion at 0, 0, 0 degrees (normal 20) with plantar flexion at 35, 30, and 35 degrees (normal 45).  The examination showed localized tenderness, no muscle spasm, guarding or abnormal gait.  

At the MEB NARSUM examination, dated 27 August 2007 (3 months before separation), the CI reported repeated giving way of his ankle and chronic pain on weight-bearing.  The history stated that “pain is exacerbated by running, marching and jumping activities as well as by prolonged standing, and gives way frequently particularly with cutting movements.”  The NARSUM physical examination noted a normal gait.  Ankle examination showed “full active range of motion;” tenderness over the anterior talofibular ligament region; no joint deformity; and no soft tissue swelling, erythema, or ecchymosis.  Drawer’s test was negative, and strength and sensation were intact.  There was no VA Compensation and Pension (C&P) examination in the record.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0% analogously coded 5099-5003, (degenerative arthritis), citing application of the U.S. Army Physical Disability Agency pain policy.  The Board considered the disparity between the PT formal ROMs (pain-limited and dorsiflexion to 0 degrees) and the NARSUM ROMs “full” as well as the reminder of the record.  The NARSUM examiner did not address ROM repetition or absence or presence of pain on motion, but was closer to the date of separation.  The NARSUM ROM and normal gait did not support the level of ankle limited motion to support a minimum rating based on limited ROM under the VASRD diagnostic code for limitation of motion (5271).  However, the Board adjudged there was sufficient evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45) based on the PT examination and history provided in the NARSUM.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to 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.  

BOARD FINDINGS:  In the matter of the left ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Ankle Pain	5099-5003	10%	
COMBINED	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 AR20160015156 (PD201500768)

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