RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00856
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050505

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” rated at 10%.

CI CONTENTION:  The CI requests the Board consider all conditions.  The 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 - 20050325	VARD - 20051206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5271	10%	Bilateral Ankle Condition	5271	NSC	20051026	
Metatarsalgia…	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had chronic right ankle pain and instability since an injury in April 2001.  On 19 November 2004, 6 months prior to separation, surgical repair of damaged right ankle ligaments (Brostrom procedure) and debridement of right ankle osteochondritis dissecans lesions (OCD - damage to a piece of cartilage and underlying bone in the ankle) were performed.  The OCD lesions affected the talus bone and the ankle portion of the distal-most end of the tibia.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “ankle pain, right, with instability postop Brostrom procedure with osteochondritis dissecans lesion” for PEB adjudication.
The MEB NARSUM on 9 February 2005, 3 months after surgery and 3 months prior to separation, recorded a chief complaint of right ankle instability and foot pain.  The ankle pain impaired his ability to participate in athletic activities and some activities of daily living.  Physical examination noted a slightly antalgic gait with “continued decrease in the range of motion at the right ankle, but within acceptable limits.”  The examiner referred to specific range of motion (ROM) measurements performed by physical therapy (PT), but these were not in evidence.  Neurological examination showed “some weakness of dorsiflexion secondary to the postoperative condition.”  There was decreased sensation on the top of the first and second toes, which the examiner reported was slowly improving after surgery.

At the 26 October 2005 VA Compensation and Pension (C&P) examination, performed 6 months after separation, 11 months after surgery, the CI reported right ankle pain rated 3-4/10 in severity, with decreased flexibility and tightness in the mornings.  He was taking Tylenol for the ankle pain and reported periodically using an ankle brace, but denied using a cane.  Daily activities were not restricted, and he could walk 2 blocks before starting to limp, but could not run.  However, he could walk 2 miles.  Physical examination showed a normal posture and gait.  The right ankle was tender, but not swollen or abnormally warm.  ROM of the ankle was recorded as dorsiflexion of 20 degrees (normal 20) and plantar flexion of 40 degrees (normal 45).  Painful motion was absent.  There was a loss of sensation on the top of the distal forefoot and toes 1-3.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (ankle, limited motion of).  The VA determined the right ankle was not service connected, based upon the C&P examination 6 months after separation, citing a lack evidence of permanent residual or chronic disability.  The Board considered rating higher than the 10% adjudicated by the PEB.  Because the C&P examination provided ratable details not evident in the NARSUM (i.e. specific ROM measurements), and was further removed from the time of surgery and therefore more reflective of a healed state, it was assigned preponderant probative value by the Board.  All Board members agreed the limitation of motion in evidence was not “marked,” therefore the highest 20% rating under 5271 was not warranted.  Although a rating could be considered under an analogous 5273 or 5262 codes for malunion of the talus or tibia, “marked deformity” or “moderate ankle disability” were not depicted by examination evidence, therefore the next higher 20% rating was not justified via these pathways.  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints and no history of astragalectomy for consideration under the respective diagnostic codes (5270, 5274).  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 chronic right ankle pain.

Contended PEB Condition:  Metatarsalgia secondary to stress fractures.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not permanently profiled or judged to fail retention standards.  The commander’s statement reflected the need for temporary profiles in 2001, 2002 and 2003 for stress fractures, but implicated the recent profile restrictions imposed by the ankle condition as impediments to duty performance.  There was no performance-based evidence from the record that the condition 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 the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic right ankle pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended metatarsalgia secondary to stress fractures condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20150606, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005113, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,