RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00959
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Linguist, medically separated for “chronic left ankle pain…” with a disability rating of 0%.  

CI CONTENTION:  The CI contends that her rating did not include all of the medical conditions evaluated and rated by the VA.  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 - 20050708	VARD - 20051013	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain…	5099-5003	0%	Status Post Left Ankle Strain Injury with Tendonitis	5299-5271	20%	20050421	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first treated for left ankle pain in condition in September 2003.  The pain resolved with physical therapy (PT) and decreased activity, but then recurred the following month with a resumption of activity.  An MRI on 10 January 2004 showed cartilage damage over the top of the ankle bone.  She was treated with a cast, crutches, and then partial weight bearing with improvement in her pain until she increased her activity.  A repeat MRI in June 2004 showed little interval improvement.  A family practice note in October 2004 recorded full range of motion (ROM) and strength with a normal gait.  She was subsequently diagnosed with osteochondritis dissecans (OCD, damage to a piece of cartilage and underlying ankle bone).  Despite treatment including surgery, the CI could not meet full duty requirements and was referred for an MEB.  The MEB forwarded “left talar dome osteochondritis dissecans” for PEB adjudication.  On 13 April 2005 she was noted to have full ROM.  Her ankle was stable.  During the MEB examination, the CI reported “increased discomfort to the left ankle while ambulating and wearing combat boots daily.”  At the VA Compensation and Pension (C&P) examination performed on 21 April 2005, 4 months before separation, the examiner recorded that the CI was limited by pain from participation in impact activities.  On examination, dorsiflexion (toes up) was normal and plantar flexion (toes down) reduced at 40 degrees (normal 45 degrees).  There was no change after repetitive use.  She had no signs of abnormal weight bearing.  The ankle was stable and showed full active ROM with tenderness.  There was no mention of painful motion nor was the gait recorded.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, coded analogous as 5099-5003 (degenerative arthritis) citing full range of motion and good stability.  The VA rated the left ankle condition 20%, coded analogous as 5299-5271 (limited motion of the ankle) citing “although [the CI’s] examination does not fully meet the 20% criteria, a 20 percent evaluation is nevertheless warranted, as the evidence, when reviewed and considered in its entirety, more closely represents a severity warranting the 20 percent evaluation, as the severity of the condition greatly affects [the CI’s] ability to complete activities of daily living.” There was no ratable limitation of motion.  Painful joint motion was not documented on examination although the CI reported pain with daily activities.  The Board determined, nonetheless, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), that there was sufficient impairment and evidence of pain with motion to support a 10% rating IAW VASRD §4.40 (functional loss) and VASRD §4.59 (painful motion) using the analogous code 5099-5003.  

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%	

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

SAMR-RB										

MEMORANDUM FOR Commander

06 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000904 (PD201500959)

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