RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02064
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060922

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “talar fracture” with a disability rating of 10%.

CI CONTENTION:  The CI makes no contentions.  The complete submission is 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 - 20060616	VARD - 20070522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Talar Fracture…	8799-8722	10%	Residuals, Left Ankle Fracture	5271	NSC	---	
			Right Ankle Condition	5271	NSC	---	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Talar Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left foot condition began in August 2004 after obtaining a fracture about the left talar (ankle) bone.  In December 2004, the CI underwent surgical resection of retained fractured fragments of the talar bone.  Since surgery, the CI complained of chronic left ankle pain with associated altered sensation. Follow-up bone scans revealed post-surgical stress reactive changes without evidence of complex regional pain syndrome (CRPS).  

At the MEB NARSUM examination on 1 March 2006, 6 months prior to separation, the CI endorsed constant left ankle/foot pain (4-8/10) described as burning and or aching.  Additionally, he endorsed a heightened degree of sensitivity to non-noxious stimuli when in contact with his left foot.  “He [the CI] now uses an assistive device to help unload his left foot when ambulating.” He denied any radicular component to his pain or bowel/bladder incontinence.  His pain was exacerbated by weight-bearing on the left foot.  He remained unable to ruck march, run, or perform most of the duties specific to his MOS due to pain.  His physical examination (PE) revealed sensitive tenderness about the top of the left foot as well as decreased range of motion (ROM) of the left ankle, noting a 66% reduction in plantar flexion and measured at 15 degrees (normal 45).  There was no comment with regards to the presence of painful motion.  There was no VA 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 at 10% using an analogous nerve code (8799-8722) neuralgia; superficial peroneal neve), citing worsening pain by all stimuli.  The VA determined the left ankle condition was not service-connected.

All panel members first agreed that the PEB’s coding approach in utilizing a nerve code was not inappropriate in this case given the increased and altered sensitivity about the left foot; however, the significant degree of limited ROM was also considered for rating under VASRD §4.71a.  The maximum rating under either code is 20%.  Panel members were left to determine if the 20% criteria level was supported under either code.  

The VASRD description of limited motion of the ankle is “moderate” or “marked” and all panel members agreed that a 66% loss of joint motion would best be described as marked impairment and in support of a 20% rating.  In consideration of the nerve code, all members did agreed that although the CI had sensitivities to all stimuli, the degree of physical reaction would best be described as moderate, thus equaling an impairment rating below 20%.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left foot condition, coded 5271.  

BOARD FINDINGS:  In the matter of the left foot condition, the panel unanimously recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  There are 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	
Left Foot Pain	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150726, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011076 , 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