RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02075
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “chronic right ankle pain” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20060405	VARD - 20070223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	Residuals, Fracture, Right Ankle	5003-5271	20%	20060928	
			Right Ankle Scar	7804	10%	20060928	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was thrown from a military vehicle while deployed in November 2004 and sustained a dislocation and fracture of the right ankle.  The dislocation was treated in theater and the CI was transferred to home station for right ankle open reduction internal fixation surgery accomplished 8 days after the initial injury.  Despite rehabilitation in physical therapy and limited duty, she continued to have pain in the ankle.  The surgical hardware was removed on 7 September 2005.  Follow up X-rays showed no change in the bony alignment which had been good.  Despite use of a walker, she continued to report pain.  

At the MEB NARSUM dated 21 February 2006, 5 months prior to separation, the CI reported ankle pain with significant activity and was unable to wear military boots.  She had a mild amount of pain with walking, stair climbing, and prolonged standing.  On physical examination, her gait was normal when barefoot or in soft shoes.  There were well healed incisions which were non-tender to palpation.  She had some mild chronic swelling about the ankle.  The right ankle range of motion (ROM) showed dorsiflexion of 5 degrees (normal 20) and plantar flexion of 40 degrees (normal 45).  The ROM of the left side was 15 degrees dorsiflexion and 65 degrees of plantar flexion.  Strength was normal and the ankle was stable.  

At the VA Compensation and Pension (C&P) examination, performed on 28 September 2006, 2 months after separation, the CI reported moderate pain.  On physical examination, her gait was normal.  The right ankle ROM following repetitive movement was dorsiflexion 0 degrees and plantar flexion of 61 degrees.  The ROM of the left ankle was 12 degrees dorsiflexion and 72 degrees plantar flexion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded analogously as 5099-5003 (degenerative arthritis), citing loss of joint motion.  The VA rated the right ankle condition 20%, coded 5003-5271 (degenerative arthritis and limited motion of the ankle), citing marked limited motion of the ankle.  The panel considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  The panel noted that a limitation of dorsiflexion to 0 degrees would support a 20% rating for a marked limitation based on the VA normal value of 20 degrees.  However, it was only limited 10 degrees for both dorsiflexion and plantar flexion compared to the uninvolved left ankle.  Moreover, the gait was noted to be normal at both the PEB and VA evaluations proximate to separation.  This is not consistent with 0 degrees of dorsiflexion.  All panel members agreed the clinical picture is more consistent with a moderate limitation of motion.  This supported the 10% rating adjudicated by the PEB.  The panel noted that the 5271 code used by the VA better described the condition, but it did not provide a higher rating or an advantage to the CI.  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 pain condition.  

BOARD FINDINGS:  In the matter of the right ankle pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150717, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014666, 
XXXXXXXXXXXXXXXXXX

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