RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01153
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Track Vehicle Repairer, medically separated for “chronic right ankle pain” with a disability rating of 0%.

CI CONTENTION:  The CI continues to have persistent ankle pain and must wear a brace.  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 - 20050104	VARD - 20050404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5009-5003	0%	Postoperative Residuals, Right Ankle Injury	5271	0%	STR	
COMBINED RATING:  0%	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 underwent right ankle surgery in June 2003 for torn ligaments (Bostrom procedure).  At the 24 October 2003 Physical Therapy appointment, the therapist noted a normal gait.  There was tenderness to palpation at the lateral malleolus.  Active range of motion (ROM) was noted to be within normal limits.  At the 17 December 2003 orthopedic appointment, the CI continued to complain of pain and the inability to run or ruck.  Despite surgical intervention, the ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “recurrent ankle pain secondary to partial tear and reconstruction of lateral collateral ligaments of the right ankle” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated July 2004, 7 months prior to separation, the CI reported pain, to include placing pressure on the ankle, swelling on days he was on his feet frequently, inability to twist or bend the ankle at times and knee swelling from limping caused by the ankle.  His physical examination (PE) revealed laxity of the right ankle with a positive anterior drawer sign.  The MEB NARSUM examination on 5 November 2004, 3 months prior to separation, the CI’s chief complaint was right ankle pain and intermittent swelling with activity.  His PE revealed a slight antalgic gait.  Ankle range of motion (ROM) was described as decreased dorsiflexion, but without numerical measurements.  There was minimal swelling and sensitivity at the surgical scar.  The CI failed to report for his scheduled VA Compensation and Pension (C&P) examination in February 2005, but a VARD dated 4 April 2005 noted a 0% rating.  The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right ankle pain 0%, coded 5099-5003 (analogous to arthritis, degenerative), citing painful and decreased motion.  The VA rated the right ankle condition 0% coded 5271 (ankle, limited motion), based on the service treatment record, citing a non-compensable evaluation.  

The Board concurred there was evidence of painful motion causing functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a higher rating.  The Board also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7), however all Board members agreed that the impairment did not more nearly approximate a moderately severe condition to support a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board agreed that the “slightness” of the CI’s gait coupled with a non-measured decrease in ROM would be more nearly approximated to a “moderate” impairment, equating to 10% under code 5271.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 10%, coded 5271.  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 Right Ankle Pain	5271	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

AR20170011786, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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