RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01106
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080516

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E2, Chemical, Biological, Radiological, and Nuclear Specialist, medically separated for “ankle sprain, right” with a disability rating of 10%.

CI CONTENTION:  “Foot swells and still in pain.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20080415	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ankle Sprain, Right…	5099-5022	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Ankle Sprain, Right.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in December 2007 when she sprained the ankle in basic training.  Imaging studies in February 2008 showed possible partial tears of a lateral ankle tendon and ligament, along with soft tissue swelling.  There was no surgical indication.  The MEB NARSUM on 3 March 2008, 2 months prior to separation, noted complaints of right ankle pain rated 6/10 in severity.  She wore an ankle brace.  Physical examination recorded a limping gait, with reduced strength in dorsiflexion (lifting the foot up) and eversion (rolling the ankle laterally to lift up the outer portion of the foot) but full strength in plantar flexion (pushing the foot down) and inversion (rolling the ankle to push the outer edge of the foot down).  There was reported pain when standing on only the right leg, and pain prevented the CI from rising up on tiptoe on the right.  At a physical therapy appointment the next day the CI reported right ankle pain rated at 2/10 in severity while at rest, which could increase to 4-5/10 with prolonged activity while on her feet.  Physical examination revealed “no deviation with gait.”  Right ankle dorsiflexion was 0 degrees (normal 20) and plantar flexion was 74 degrees (normal 45).  Pain was reported in all planes, and the limitation of motion was attributed to muscle tightness and “most likely joint stiffness due to disuse.”  There was no VA examination in evidence proximate to separation.
  
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle sprain 10%, coded 5099-5022 (analogous to periostitis), citing limited range of motion with pain on use.  The panel considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  Panel consensus was that the ROM measurements in evidence reflected marked limitation of motion, and therefore the highest 20% rating was warranted under the 5271 code.  Since ankylosis was not present, a higher rating also was not supported under the 5270 or 5272 codes.  There was likewise no malunion of the talus or calcaneus “with marked deformity” to warrant a rating under the 5273 code.  The 5262 code (tibia and fibula, impairment of) and 5284 code (foot injuries, other) were inapplicable or did not result in a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right ankle sprain condition, coded 5271.

BOARD FINDINGS:  In the matter of the ankle sprain, right, condition the panel majority recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  There were no other conditions within the panel’s scope of review for consideration.  The panel 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	
Ankle Sprain, Right	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150610, w/atchs
Exhibit B.  Service Treatment Record

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Dear XXXXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,
Enclosure