RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01300
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080924

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “bilateral ankle pain,” rated 10% right and 10% left, with a combined disability rating of 20%.

CI CONTENTION:  “I still have issues with both of my ankles going out on me…I have to wear braces in order to walk…”  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 – 20080821	VARD - 20090521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Ankle Pain	5099-5003	10%	Right Ankle Pain	5271	NSC	STR	
		10%	Left Ankle Pain	5271	NSC	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bilateral ankle pain began in April 2007 during prolonged runs.  Ankle X-rays in April 2007, December 2007, and June 2008 were all normal.  Despite treatment, the bilateral ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and she was referred for an MEB.  The MEB forwarded bilateral ankle pain for PEB adjudication.  

At the 16 June 2008 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported bilateral ankle pain and stiffness and a history of twisting her ankles.  Pain was aggravated with activity such as walking or jumping.  The physical examination documented a normal posture and gait.  The bilateral ankle examination revealed normal appearance with no swelling, erythema (redness), ecchymosis (bruising), or tenderness.  There was no tenderness in the posterior and anterior talofibular nor calcaneofibular ligaments, also referred to as PTFL, ATFL, CFL, respectively.  Active range of motion (ROM) was dorsiflexion of 20 (normal 20) and plantar flexion of 45 (45) degrees.  There was no limitation in ROM from pain, fatigue, weakness, or lack of endurance with repetitive use.  The right anterior drawer test (assesses ATFL) was positive and the bilateral talar tilt tests (assesses CFL) were negative.  Strength, sensation, and deep tendon reflexes were normal.  On 18 July 2008 physical therapy (PT) measured repetitive ROM with a goniometer for the MEB.  Right ankle active ROM was dorsiflexion of 20 (20) and plantar flexion of 60 (45) degrees.  Left ankle active ROM was dorsiflexion of 15 (20) and plantar flexion of 60 (45) degrees.  There was no limitation of motion after repetitions, due to pain, fatigue, weakness, lack of endurance, or incoordination.  There was pain with dorsiflexion in both ankles, but no pain with plantar flexion.  There was no muscle atrophy, muscle spasm, swelling, or scarring.  The physical therapist opined, “I do not believe the patient will have any functional limitation due to a loss of ROM.  Normal dorsiflexion for gait is 10 degrees, well within this patient's measurements.”  

The 22 July 2008 MEB NARSUM, 2 months before separation, noted complaints of pain, intermittent swelling, and frequent popping sounds in her ankles.  The CI felt her ankles tended to roll inward very easily.  She was referred to orthopedics for surgical consideration, was only given a 50% change of improvement, and decided against surgery.  The Office of the Surgeon General’s orthopedics consultant reviewed the medical records and concluded the CI’s refusal for surgery was reasonable.  Pain continued and the CI reported an unsteady feeling.  Physical examination documented a normal gait and tenderness over the lateral ankle joint bilaterally.  There seemed to be tenderness over the lateral talocalcaneal ligament and the ATFL ligaments of both ankles,    and minimal tenderness in the medial area of either ankle.  There was no swelling and the CI was taking no medication.  ROM was noted to be good and referenced the PT examination for MEB ROM measurements.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left ankles 10% and 10%, coded 5099-5003 (analogous to arthritis, degenerative), citing limitation of motion of one major joint on each side.  The VA denied service connection for both ankles, citing the CI failure to show for the 20 April 2009 C&P examination.  The VA used the STR records available and did not reference the 16 June 2008 C&P examination.  

The Board concurred that a 10% rating for functional loss (§4.40, §4.45, §4.59) due to pain was appropriate as adjudicated by the PEB.  All members agreed the limitation of motion was not marked to support a 20% rating under 5271.  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints, no malunion of the os calcis (calcaneus) or astragalus (talus) or astragalectomy for consideration under the respective diagnostic codes (5270, 5272, 5273 or 5274).  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 moderately severe to support a higher rating.  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 for the right and left ankle conditions.  

BOARD FINDINGS:  In the matter of the right and left ankle conditions 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 20150617, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170005989, XXXXXXXXXXXXXXXXXX. 

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Dear XXXXXXXXXXXXXXXXXX:

	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,