RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01702
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20020418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Medical Equipment Repairer, medically separated for right ankle pain 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 – 20020225 	VARD – 20020425 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Ankle	5099-5003	10%	Right Ankle Anterolateral Impingement Synovitis	5271	10%	STR	
Environmental Allergies	Not Unfitting	Allergic Rhinitis	6522	0% 	STR	
Patellofemoral Pain Syndrome (PFPS) Worse on the Right than the Left	Not Unfitting	PFPS, Right Knee	5260	0%	STR	
		PFPS, Left Knee	5260	0%	STR	
Mechanical Low Back Pain	Not Unfitting	Lower To Mid Back Pain	5295	NSC	STR	
Left Shoulder Pain	Not Unfitting 	Left Shoulder Pain (Minor)	5203	NSC	STR	
Combined Rating:  10%	Combined Rating of all VA Conditions:  10%	

ANALYSIS SUMMARY:  

Right Ankle.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a right ankle injury in October 2000 during physical training.  Serial right ankle X-rays on 1 December 2000 and 10 January 2001, were unremarkable.  The 31 January 2001 right ankle magnetic resonance imaging (MRI) suggested a partial tear of the anterior talofibular ligament.  However, the MRI was reread by a second opinion Radiologist as negative.  Evaluation by orthopedics concluded with a diagnosis of right ankle instability, and recommended surgical treatment.  Surgery was declined by the CI, but his informed decision to decline was considered reasonable.  Despite treatment, the ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  

The 31 January 2002 MEB NARSUM examination, 3 months prior to separation, noted that the CI continued to have chronic ankle pain and swelling.  He was not able to do any significant amount of activity on the ankle without causing substantial pain.  On examination mild right ankle swelling was noted.  The examiner deferred to the physical therapy consult.  The 9 February 2002 physical therapy consult examination, 3 months prior to separation, noted complaints of chronic right ankle instability and limitation of motion.  On examination, the CI was able to deep squat, and lift his heels off the floor.  The examiner also noted tight Achilles tendons bilaterally.  The right ankle range of motion (ROM) was dorsiflexion of 0 degrees (normal 20) and plantar flexion of 70 degrees (normal 45).  There was no VA Compensation and Pension examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded analogously to 5003 (degenerative arthritis), citing slight pain, not requiring daily narcotic therapy/frequent, with application of the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA rated the right ankle condition 10%, coded 5271 (limited motion of the ankle), based on the STR.  The panel considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  The panel agreed that the ROM examinations proximate to separation detailed above were consistent with a moderate limitation of motion for the 10% rating under this code due to the CI’s ability to deep squat and lift heels off floor.  A higher rating of 20% was not indicated in the absence of marked limitation of motion of the ankle.  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 panel also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7), however all panel 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right ankle condition.  

Contended PEB Conditions:  Environmental Allergies, Patellofemoral Pain Syndrome Worse on
the Right than the Left, Mechanical Low Back Pain, and Left Shoulder Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

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.  In the matter of the contended environmental allergies, patellofemoral pain syndrome worse on the right than the left, mechanical low back pain, and left shoulder pain conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were 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 20150706, w/atchs
Exhibit B.  Service Treatment Record

AR20170008720, 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.