RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01913
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an  E4, Cannon Crewmember, medically separated for “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 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 - 20060228	VARD - 20070125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5271	10%	Fracture of the Left Ankle S/P IF, with Residuals	5271	20%	20061006	
			Scar, Left Ankle Associated with Fracture…	7804	0%	20061006	
Hypercholesterolemia	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgery for an open reduction and internal fixation (ORIF) of a left ankle fracture in March 2003.  
 
During the 5 December 2005 MEB examination (recorded on the NARSUM and DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported “decreased flexibility and pain with weight bearing of the left ankle.”  Physical examination showed full dorsiflexion and plantar flexion of the left ankle without pain or ligamentous instability.  During the MEB podiatry examination, 12 December 2005, 5 months prior to separation, the CI reported “decreased flexibility and pain with weight bearing of the left ankle.”  Physical examination showed decreased dorsiflexion of 5 degrees (normal 20), but the examiner did not record the CI’s plantar flexion.  The CI also had minimal tenderness to palpation about the left ankle.  There was no mention of pain with ROM movements.  At the physical therapy examination on 13 December 2005, 5 months prior to separation, the CI’s ROM was limited to 10 degrees dorsiflexion and 40 degrees plantar flexion of the left ankle (compared to 15 degrees dorsiflexion and 40 degrees plantar flexion of the right ankle).  

At the 6 October 2006 VA Compensation and Pension (C&P) examination, performed 5 months after separation, the CI complained of stiffness and swelling in the left ankle, especially with standing or walking more than 40 minutes.  The CI reported tenderness over his left ankle surgical scar with shoe wear.  The examiner recorded that the CI had “no episodes of dislocation or subluxation.”  Physical examination showed a normal gait with limitation of motion of dorsiflexion to 5 degrees, while plantar flexion was normal at 45 degrees.  There was no mention of painful motion, “no change in the examination with repetitive motion,” no significant tenderness, and no tenderness of the surgical scars.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5271 (limited motion of the ankle).  The VA rated the left ankle condition 20%, coded 5271, based on the C&P examination 5 months after separation, citing marked limited motion of the ankle.

The panel considered rating under the diagnostic code 5271, limited ankle motion, with a focus on whether the limitation of motion was moderate or marked.  Although the VA rated the left ankle condition at 20% for marked limitation of motion, panel members agreed the limitation of motion was no more than moderate because the VA examination indicated that the CI’s gait was normal, thereby supporting the 10% rating adjudicated by the PEB, as well as the fact that plantar flexion was normal.  A higher rating of 20% was not indicated in the absence of marked limitation of motion.  The panel next considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to 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 approximate moderately severe to support a higher rating of 20%.  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: Hypercholesterolemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the condition was not unfitting.  The condition was not profiled or implicated in the commander’s statement and was judged to not fail retention standards.  There was no performance based evidence from the record that the condition significantly interfered with satisfactory duty performance.  Hypercholesterolemia is not a physical disability and is not ratable. After due deliberation in consideration of the preponderance of the evidence, 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 hypercholesterolemia condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 20150711, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009285, 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.

Sincerely,					       
						      					
Enclosure