ECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01435
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20070715

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

CI CONTENTION:  “Review all conditions.”  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 - 20070523	VARD – 20130506 (out of scope)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain And Mild Instability Right Ankle	5099-5003	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Pain and Mild Instability Right Ankle.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s ankle condition began in September 2005 while deployed to Iraq after jumping off a tank, and twisting his ankle.  Magnetic resonance imaging (MRI) from 8 August 2006, demonstrated a normal distal tibia and abnormalities of the talofibular, calcaneofibular, and tibiotalar ligaments suggesting prior injury.  

At the 28 August 2006 physical therapy (PT) appointment, the CI reported right ankle (RA) pain and decreased range of motion (ROM) with swelling after activity.  Pain severity was noted at 6-7/10.  The examiner reported normal appearance of the ankle, bilaterally.  There was tenderness on palpation of the medial and the lateral aspect of the RA.  RA ROM was limited to neutral in dorsiflexion and plantar flexion was within functional limits (WFL).  The RA anterior drawer sign was observed and the talar tilt test was positive.  

During the 18 October 2006 PT appointment, the examiner noted RA tenderness to palpation of the lateral aspect.  There was no tenderness on palpation of the medial aspect.  Active motion was limited to neutral in dorsiflexion.  Plantarflexion was WFL.  Anterior drawer sign was observed and a talar tilt test was positive.  

During the 16 November 2006 PT appointment, the CI complained of RA pain that was more severe since initiating therapy.  The examiner reported the RA ankle appearance as normal without swelling and erythema.  There was tenderness on palpation of the medial and lateral aspect.  On examination the RA ROM showed dorsiflexion of 5 degrees (normal 20 degrees).  RA plantarflexion was WFL.  Anterior drawer sign was not observed.  The talar tilt test was negative.  X-rays on 17 November 2006, were read as normal with the following pertinent negatives noted, no fracture, no dislocation with the ankle joint mortise and Taylor dome intact.  

At the 29 January 2007 orthopedic appointment, the CI complained of localized joint pain of the RA.  Examination of the RA noted lateral and medial ankle tenderness, slight anterior drawer, and no marked effusion or increase in inversion.  There was no swelling, erythema or warmth of the ankles.  The orthopedist assessment was joint pain localized in the RA; anterior lateral impingement versus subtle ankle instability.

MRI on 5 April 2007, was read as normal, except for some increase in signal was seen in the anterior talofibular ligament consistent with a past sprain of that ligament and without chondral abnormalities.  

At the 10 April 2007 MEB NARSUM examination, 3 months prior to separation, the CI complained of right ankle pain.  This pain was reported as shifting from the medial to the lateral aspect of his right ankle.  It was associated with swelling, but did not complain of “giving way” of his right ankle.  He was very selective about the surfaces he walked over and the pain was present at least three quarters of the day.  It was also present at night.  The CI did not take pain medicine for this condition, but was limited in his walking to a half mile.  He stated that he could only stand for 15 to 20 minutes after which he had to sit down.  He further stated he was unable to run and jump.  The RA ROM examination revealed a dorsiflexion of 5 degrees (normal 20 degrees) and plantar flexion of 55 degrees (normal 45 degrees).  There was a small right ankle effusion.  There was tenderness to palpation over the anterior lateral joint line and a slight anterior drawer sign at the right ankle.  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 ankle condition 10%, coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  

The panel concurred that a 10% rating for a moderate RA limitation of motion, which was recorded at the time of the MEB NARSUM examination and in accordance with (IAW) VASRD diagnostic code (DC) 5271.  Also, it was noted there was pain with use and slight laxity of the RA.  All members agreed the limitation of motion was not “marked,” therefore the next higher rating under VASRD DC 5271 was not justified.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 and 4.7, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the 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 are no other conditions within the panel’s scope of review for consideration.  

The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170017917, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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