RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01732
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090927

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard, O2, Financial Manager, medically separated for “chronic left ankle pain,” with a disability rating of 10%.  

CI CONTENTION:  Contended a higher rating for ankle and knee 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 - 20090625	VARD - 20091218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle	5099-5003	10%	Left Osteochondral Lesion, Lateral Talus	5099-5003	0%	STR	
Left Knee	Not Unfitting	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Ankle.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in June 2006 after twisting his left ankle while deployed.  Imaging studies (MRI) showed some abnormality and fragmentation around the ankle and edema in the bone marrow.  The CI underwent multiple surgeries including allograft from the left knee (11 months prior to separation) and arthroscopic debridement in October 2008 (11 months prior to separation).  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left knee pain related to donor plug site” for PEB adjudication.  
The February 2009 physical therapy examination showed weakness with both plantar and dorsiflexion of the left ankle.  ROM was stated as “dorsiflexion was normal” with a value of 10 degrees (VASRD normal is 20).  The CI was able to perform 1-2 heel raises with minimal pain.  The CI was unbalanced walking on heels.  In March 2009, the ankle ROM was normal and there was no effusion.  The CI was able to perform 1-2 heel raises with minimal pain.  There was no effusion and no sensory abnormalities were noted.  There was no crepitus or ligamentous instability on examination, and there was a well-healed surgical scar.  The 25 April 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of left ankle pain and decreased activity to manage his pain.  The physical examination showed a chronology of range of motion (ROM) evaluations beginning in December 2008 noting painful left ankle motion of 14 degrees of dorsiflexion (normal 20) and 42 degrees of plantar flexion (normal 45) with weakness on flexion.  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 left ankle condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing limitation of motion.  The VA increased the left ankle 0% rating to 10%, effective in 2014, based on VA examination in 2014, citing painful motion and evidence of joint degeneration.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However, there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45) as 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.  

Contended PEB Condition:  Left Knee.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled.  Although it was implicated in the commander’s statement, the MEB adjudged that the condition did not fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left knee condition, the panel unanimously recommends no change from the PEB determination 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 20150703, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170008884, 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