RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01027
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080829

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “right ankle, loss of motion…,” with a disability rating of 10%.  

CI CONTENTION:  The CI did not submit a contention in the application.  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 - 20080812	VARD – 20081029	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle, Loss of Motion	5271	10%	Fracture, Medial Malleolus, Right Ankle	5271	0%	2080927	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Ankle, Loss of Motion.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI fractured her right ankle (non-displaced medial malleolus) on 1 April 2008 (5 months before separation) from a fall on an obstacle course early in basic training.  This was treated with immobilization and progressive ambulation.  There were no outpatient STR entries probative to gait, range of motion (ROM), or other VASRD-ratable findings.  The CI suffered persistent pain after surgical recovery and the NARSUM orthopedist opined, “There is no surgical procedure or rehabilitation program that would prepare her to successfully complete military training in a timely fashion.”  She was referred for an MEB which in turn forwarded “right medial malleolus fracture pain” to the PEB.

The NARSUM examination on 24 June 2008 (2 months before separation) documented chronic ankle pain (unquantified) prohibiting resumption of training as above.  The physical examination recorded poor right foot propulsion with gait, tenderness, “minimal” edema, and normal neurovascular findings.  Goniometric ROM measurements for the MEB by physical therapy were dorsiflexion to 15 degrees (normal 20) and plantar flexion to 40 degrees (normal 45), specifying painful motion and no degradation with repetitions. 

A VA orthopedic Compensation and Pension (C&P) examination on 27 September 2008 (a month after separation) documented a complaint of “residual pain and swelling,” occasional use of a brace, and weekly “severe” flares with “excessive” standing or walking; although, the examiner noted that the CI was employed full time (non-sedentary) and was “able to stand 3 to hours ... [with] ... no limitation to walking.”  The physical examination recorded a normal gait (also noted in a general C&P examination the same day), tenderness, and “increased laxity [to] anterior stress.”  Measured ROM was normal for both dorsiflexion and plantar flexion, specifying the absence of painful motion or degradation with repetitions.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated 10%, coded 5271 (limitation of motion) citing “moderate” limitation.  The VA rated 0%, coded under the same code citing normal ROM without painful motion or DeLuca deduction.  The 5271 code confers a 20% rating for “marked” limitation; but, members agreed that the 25% loss of dorsiflexion and minimal reduction in plantar flexion reflected by the MEB measurements could not be reasonably characterized as marked ROM limitation.  Given the absence of ankylosis, nonunion, or malunion, VASRD §4.71a offers no applicable code which would yield a rating higher than 10% for this case.  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 of the right ankle condition.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20150608, 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

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001069 (PD201501027)

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, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA