RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00917
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20031101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Multiple Launch Rocket System Crewmember, medically separated for “limitation of motion, right ankle,” with a disability rating of 10%.

CI CONTENTION:  Condition continues to worsen and negatively impact daily activities.  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 - 20030915	VARD - 20030926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Limitation of Motion, Right Ankle	5271	10%	Residuals of Right Ankle Fracture	5271	20%	20030731	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Right Ankle.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle fracture occurred in October 2002 after stepping in a hole.  Radiographic imaging (X-ray) revealed a right distal tibia fracture with possible ligamentous injury.  He underwent surgical fixation on 7 October with implantation of screws and a bridge plate.  Nearly 3 months later, after removal of the hardware, the CI’s follow-up X-rays revealed mild degenerative joint changes without any “…loosening of the right ankle joint.”  Despite surgical intervention and post-surgical restrictive treatment, the CI’s condition did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right ankle pain post traumatic (degenerative disc disease [DDD])” for PEB adjudication.

At the MEB NARSUM examination dated 14 May 2003, 5 months prior to separation, noted complaints of right ankle pain which prevented running, wearing a backpack, or participating in physical training exercises.  Physical examination revealed moderate surgical scar swelling and range of motion (ROM) of dorsiflexion 10 degrees (normal 20) and plantar flexion 25 degrees (normal 45); painful motion was not addressed.  

At the VA Compensation and Pension (C&P) examination dated 31 July 2003, 3 months prior to separation, noted complaints of right ankle pain with weight-bearing and motion.  Physical examination revealed ROM of dorsiflexion to 5 degrees and plantar flexion to 20 degrees with painful motion.

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).  The VA rated the right ankle condition 20%, also coded 5271 based on the C&P examination 3 months before separation, citing painful limited motion.  The Board agreed the STR and VA evidence supported a “marked” ankle limitation of motion rated 20% coded 5271; corroborated by the 50% loss of plantar flexion and 75% loss of dorsiflexion cited by the aforementioned examinations most proximate to separation.  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints, no malunion of the os calcis (calcaneus) or astragalus (talus) or astragalectomy for consideration under the respective codes (5270, 5272, 5273 or 5274) to assign a rating.  The Board considered code 5284 (other foot injuries) and determined that the CI’s impairment did not more nearly approximated “severe” to support a higher rating.  The Board also considered the CI’s fractured tibia code 5262 (impairment of the tibia, fibula and ankle), and determined the evidence did not support a malunion or nonunion at the time of separation to assign a rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the right ankle condition, coded 5271.

BOARD FINDINGS:  In the matter of the right ankle condition, the Board unanimously recommends a disability rating of 20%, 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 the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Limitation of Motion, Right Ankle	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150606, 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 
XXXXXXXXXXXXXXXXXX, AR20170000851 (PD201500917)

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