RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01524
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090122

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

CI CONTENTION:  The CI made no specific contention.  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 - 20081017	VARD - 20100318	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Joint Pain…	5003	10%	Right Ankle Fracture	5271	NSC	20100104	
Left Ankle Joint Instability	5099-5001	10%	Left Foot Strain	5284	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Ankle.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a distal fibular fracture in 1999 prior to entering active duty, with subsequent pain.  He reenlisted in May 2006, and continued to pass the physical fitness tests despite persistent pain.  Radiographic imaging (MRI) in July 2008 showed arthritis (effusion, osteophytes, and thinning cartilage) and talar bone edema, suggestive of posterior impingement.  

The MEB NARSUM examination on 8 October 2008, 3 months prior to separation, noted complaints of constant pain worsened with running, walking on uneven ground, or while bearing heavy loads.  The physical examination showed full range of motion (ROM) and evidence of painful motion.  

At the 4 January 2010 VA Compensation and Pension (C&P) evaluation, performed 12 months after separation, the CI reported the use of an ankle brace; and pain, stiffness, limited motion, instability and swelling of the ankle with weekly flare ups.  The physical examination showed a normal gait, dorsiflexion of 5 degrees (normal 20), plantar flexion of 35 degrees (normal 45), and evidence of painful motion.  An addendum dated 24 February 2010 noted no radiographic evidence of bony or soft tissue abnormality.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the right ankle condition, coded 5003 (degenerative arthritis), citing a limited ROM with painful motion and radiographic evidence of arthritis.  The PEB also acknowledged that the right ankle condition existed prior to service and was permanently service aggravated.  The VA rated did not service connect the right ankle condition based on the VA C&P examination 12 months after separation, citing that the right ankle condition existed prior to service and no evidence of permanent worsening while in the service.  

The PEB determined the right ankle condition existed prior to service and was permanently service aggravated.   There was no limitation of dorsiflexion or plantar flexion that supported a higher rating under the VASRD diagnostic code for limitation of motion (5271).  The panel concurred that a 10% rating for functional loss (§4.40, §4.45, §4.59) due to pain and evidence of arthritis was appropriate as adjudicated by the PEB.  The panel also considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  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.  

Left Ankle.  According to the STR and the MEB NARSUM, the CI’s left ankle condition began in June 2007 with “popping and cracking” and instability without specific injury or trauma, other than recurrent “twists.”  Radiographic imaging (X-ray and MRI) in June 2008 showed no evidence of fracture, dislocation, or arthritis, however there was evidence of tenosynovitis (peroneal and Achilles tendon) and a thinned lateral ankle (anterior talofibular) ligament, consistent with prior injury.  

The MEB NARSUM examination on 8 October 2008, 3 months prior to separation, noted complaints of instability after experiencing “popping and cracking” of left ankle.  Use of an ankle brace for stabilization was helpful during activities of daily living, but not adequate for running, walking on uneven ground or when carrying heavy loads.  The physical examination showed full ROM with “some laxity.”  

At the C&P evaluation the CI reported lateral and distal discomfort of the foot with pain, stiffness, and fatigability.  The physical examination showed a normal gait, calluses at the great toe and posterior heel, and no evidence of flat foot.  There was no documented ankle examination.  Radiographic evaluation showed no evidence of soft tissue swelling, fracture or destructive bony lesions, with well-maintained joint spaces.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the left ankle condition, analogously coded 5099-5001 (degenerative arthritis hypertrophic or osteoarthritis), citing painful and limited motion, joint instability, with radiographic evidence of tendinopathy.  The VA rated 0% for the left ankle condition, coded 5284 (other foot injuries), based on the C&P examination citing subjective pain, no physical abnormalities, and no radiographic evidence of degenerative joint disease.  There was no limitation of dorsiflexion or plantar flexion that supported a higher rating under the VASRD diagnostic code for limitation of motion (5271).  There was no consistent evidence of painful motion causing functional loss, however, the panel concurred that a 10% rating for functional loss (§4.40, §4.45, §4.59) due to subjective pain and instability was appropriately adjudicated by the PEB.  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 left ankle condition.  

BOARD FINDINGS:  In the matter of the right and left ankle conditions 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 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20170008571, 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