RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01621
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090529

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E1, Trainee, medically separated for “chronic left ankle pain,” with a disability rating of 10%.

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 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 - 20090512	NO VA CLAIM	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5271	10%	--	--	--	--	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  There was a paucity of source clinical notes in the available service treatment record (STR) for this case, and the Board’s recommendation was derived primarily from the Medical Evaluation Board (MEB) narrative summary (NARSUM) and core military Disability Evaluation System documents.  The CI twisted her ankle during training in December 2008 (6 months prior to separation).  She was diagnosed (MRI) with a cortical avulsion fracture (bone chip) of the lateral malleolus.  Pain persisted and an orthopedic consultant opined surgery was not indicated and recommended an MEB.  The MEB determined the CI would not be able to resume training in a timely fashion and forwarded “chronic left ankle pain due to residual of lateral malleolar avulsion injury” to the PEB.

The NARSUM examination on 30 April 2009 (a month prior to separation) documented daily pain with flare-ups when marching and intermittent swelling.  The physical examination recorded a normal gait, lateral tenderness, joint stability to stress testing, and 5/5 strength.  The NARSUM cited goniometric range of motion (ROM) measurements by physical therapy from a month earlier.  These were (after 3 repetitions) dorsiflexion to 6 degrees (normal 20) and plantar flexion (PF) to 60 degrees (normal 45), specifying painful motion.  

There was no VA claim, evaluation, or medical care on file; and, there was no other post-separation evidence in this case.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating was under code 5271 (limited motion of the ankle) citing the VASRD §4.71a criterion of “moderate” limitation.  Code 5271 confers a 20% rating for “marked” limitation, but members agreed that the ROM evidence (fully preserved plantar flexion) was more reasonably characterized as moderate limitation.  Given the absence of ankylosis or malunion, the VASRD offers no applicable joint code which would yield a rating higher than 10% in this case.  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 of the left ankle condition.    

BOARD FINDINGS:  In the matter of the left ankle condition 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 20150622, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001299 (PD201501621)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA