RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01865
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Signal Support Systems Specialist, medically separated for “right ankle pain,” with a disability rating of 0%.

CI CONTENTION:  The CI has made a contention for right ankle, left foot, and migraine headaches.  The CI’s 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 panel 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 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 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 - 20030304	VARD - 20030415	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5099-5003	0%	Right Ankle Repair, with Residuals	5271	20%	20020618	
			Right Ankle Scar	7804	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right ankle surgery in March 2001 for right peroneal tendon repair.  The CI reinjured her ankle and underwent surgical stabilization in December 2001.  Following the two surgeries, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “post right peroneal tenosynovectomy & repair & post right ankle stabilization” for PEB adjudication.  At the time of the Podiatry clinic appointment on 15 May 2002, 11 months prior to separation, the CI was 5 months after right ankle surgery, was wearing a Hi-Tec boot, reported ankle pain, and felt that the ankle was stable.  Physical examination showed no edema, a dorsiflexion of 15 degrees (20 normal), no pain with dorsiflexion movement, tender to palpation, and decreased sensation.  At the 18 June 2002 VA Compensation and Pension (C&P) examination, performed 10 months before separation; physical examination showed moderate limited dorsiflexion of 15 degrees (20 normal) and plantar flexion of 30 degrees (45 normal).  There was no evidence of swelling, atrophy, or instability.  Radiographic (X-ray) studies on 18 June 2002, sensory perception, strength, vascular supply, and reflexes were all normal.  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 18 October 2002, 7 months prior to separation, the CI reported ankle pain since July 2000 after airborne operation, two ankle surgeries, and that she wore an ankle brace every day that had been prescribed.  Physical examination showed tender to palpation, negative Drawer test, mild varus laxity, negative valgus laxity, nerve was intact, and strength was normal.  At the time of the physical therapy appointment on 24 October 2002, for range of motion (ROM) measurements, the examiner recorded a dorsiflexion of 15 degrees and a plantar flexion of 40 degrees (normal 45).  The MEB NARSUM on 16 December 2002, 4 months prior to separation, noted X-ray studies were within normal limits, no edema, dorsiflexion of 7 degrees, mild pain with inversion, normal strength, negative anterior drawer, decreased sensation, and mild tenderness with palpation along the superior retinaculum and anterior tilt of her ligament region.  At another MEB NARSUM examination on 19 February 2003, 2 months prior to separation, the examiner recorded ROM measurements as dorsiflexion of 15 degrees and plantar flexion of 40 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, analogously coded 5003 (arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA rated the right ankle condition 20%, coded 5271 (ankle, limited motion of; marked).  The VA additionally rated the right ankle surgical scar at 10% under code 7804 (scar(s), unstable or painful).  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 a 10% rating (based on §4.59, §4.40 and §4.45).  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).  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a higher rating.  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 a moderately severe condition to support a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right ankle pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the right ankle pain condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Ankle Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150707, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009224, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure