RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01277
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Bradley Linebacker Crewmember, medically separated for “right ankle instability” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  His 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 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 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 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 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 - 20040308	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Instability	5299-5262	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Ankle Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in September 2002 after stepping in a hole.  A 21 July 2003 right ankle diagnostic imaging (MRI) study showed a superior-medial talus osteochondral (bone and cartilage) injury, Achilles tendon insertion edema (excess tissue fluid swelling), and mild posterior tibial tendon tendinopathy (chronic localized tendon thickening).  A 3 February 2004 right ankle X-ray showed a possible osteochondral lesion of the talar dome.  Despite treatment, 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 MEB. 

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 5 January 2004, 4 months prior to separation, the CI reported “numbness and tingling in right ankle with loss of complete feeling over whole ankle.”  Physical examination showed “right ankle laxity.”  In the 13 January 2004 NARSUM, 4 months before separation, the CI complained of right ankle 7-8/10 pain and instability for over a year.  He did not experience significant relief from conservative management (activity modification, physical therapy [PT], casting for 1 month, controlled ankle motion [CAM] walker, ankle braces, arch supports, and medication).  The right ankle examination revealed Achilles tendon tenderness (posterior insertion at calcaneus and proximal musculotendinous junction).  There was no erythema (redness), edema, ecchymosis (bruising), scars, cysts, lesions, tendon thickening, or subtalar joint hypermobility.  “His neurovascular status is decreased to the right heel, plantar arch, medial and lateral malleoli.”  The posterior tibial nerve Tinel's sign (percussing nerve elicits tingling over distribution of the nerve) was negative.  Right ankle dorsiflexion was 5 (20 normal) degrees “...with patient complaining of tightness and pulling.”  The anterior drawer (assesses anterior talofibular ligament) and talar tilt (assesses calcaneofibular ligament) tests were negative.  “On stance, he is unable to do the one-legged stance on his right due to instability and his falling over.”  The examiner recounted the findings of the MRI and X-rays.  The diagnosis listed right ankle instability and equinus (limitation of dorsiflexion of ankle joint).  On 3 February 2004, PT measured repetitive (X3) range of motion (ROM) by for the MEB.  Right ankle dorsiflexion was 10/11/9 (20) and plantar flexion of 39/41/41 (45) degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5262 code (tibia and fibula, impairment of) citing right ankle training accident, sprain, Achilles injury, instability, some decrease in sensation, and 20% loss of ROM.  There was no tibia and fibula nonunion/malunion (5262), ankle ankylosis (5270), subastragalar or tarsal joint ankylosis (5272), os calcis or astragalus malunion (5273) or excision of the astragalus (5274) for consideration under the respective codes.  The panel assigned more probative value to the ROM measured by PT for the MEB because it measured repetitive dorsiflexion and plantar flexion.  The panel assigned less probative value to the NARSUM ROM because it only measured dorsiflexion.  Panel members agreed that the ROM values more closely approximated the moderate (10%) than the marked (20%) rating under 5271 (ankle, limited motion of).  The panel agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right ankle condition.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150609, w/atchs
Exhibit B.  Service Treatment Record

AR20170007546, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure