RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01342
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, M1 Armor Crewman, medically separated for “chronic right ankle pain” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  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 upon a 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 - 20070209	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	0%	No VA Claim Filed	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Ankle.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his right ankle in March 2004 during training.  Radiographic imagining (X-ray) revealed a fracture of the distal tibia including the ankle joint.  He was initially treated conservatively (activity modification, physical therapy, and mediations), but his pain persisted and surgery to remove a loose body was accomplished that August.  

The 29 August 2006 MEB NARSUM, 8 months before separation, noted complaints of right ankle pain.  The physical examination revealed a normal gait, tenderness along dorsum of foot with right ankle range of motion (ROM) of 45 degrees (normal 45), dorsiflexion 25 (normal 20) with painful motion.  Stress X-rays did not show evidence of instability.  At an orthopedic evaluation, performed on 19 September 2006, 7 months before separation, the CI reported right ankle pain, since his surgery, which was aggravated by activity.  The physical examination showed a normal gait without sensory abnormalities.  There was no swelling, erythema or tenderness.  The ROM was normal and pain free.  He was noted to still be unable to run/ruck/load bear.  There was no VA Compensation and Pension examination proximate to separation in evidence. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy rated as minimal/intermittent pain.  The panel based its recommendations on the VASRD in effect at the time of separation. The VA did not rate this right ankle condition because the CI did not file a VA disability claim.  The panel agreed there was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for ankle limitation of motion (5271).  Although not documented on a subsequent orthopedic evaluation, painful motion causing functional loss was recorded on the NARSUM which supported a 10% rating (based on §4.59, §4.40 and §4.45).  There was no ankylosis, malunion, or excision of the ankle bones for consideration under the respective diagnostic codes (5270, 5272, 5273 or 5274).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right ankle condition IAW §4.59 (painful motion) analogously coded 5299-5271.  

BOARD FINDINGS:  In the matter of the chronic right ankle pain condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5271 IAW VASRD §4.71a.  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	
Chronic Right Ankle Pain	5299-5271	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007557, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	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