RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02145
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020619

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Fighting Vehicle Infantryman, medically separated for “chronic pain, left ankle,” with a disability rating of 0%.

CI CONTENTION:  The CI contends his injuries were not fixed, particularly, his left ankle.  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 - 20020423	VARD - 20020628	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Ankle	5099-5003	0%	Traumatic Arthritis and Medial Talar Dome Osteochondral Defect, Left Ankle	5010-5271	10%	20020220	
GERD	Not Unfitting	Hiatal Hernia w/ GERD…	7346	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Ankle.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left ankle surgery in August 1999 (medial talar dome defect and ligament repair) and February 2001 (follow-up medial talar dome osteochondral defect).  Following the surgeries, further treatment did not result in improvement sufficient to allow unrestricted duty.  

On 6 November 2001 podiatry clinic appointment, 7 months prior to separation, the CI reported the use of a cam walker and continued pain to the medial side of the ankle.  On examination the CI experienced tenderness to palpation with mild crepitus noted.  Range of motion (ROM) measurements showed dorsiflexion 12 degrees (normal 20) and plantar flexion (normal 45 degrees.)

At the 20 February 2002 VA Compensation and Pension (C&P) examination, performed 4 months before separation, the CI reported complaints of pain, weakness, stiffness, inflammation, instability, fatigue and lack of endurance.  Flare ups occur with prolonged standing, walking of unstable surfaces.  He changed to slip on shoes as he could not squad down due to pain.  Physical examination showed normal weight bearing on the feet and the CI used a cam walker and ankle brace.  The examiner noted abnormal ankle movement and instability.  ROM measurements showed dorsiflexion to 15 degrees and plantar flexion to 30 degrees.  At the 21 March 2002 MEB NARSUM examination, the CI reported continued daily pain that was worse in the evening and aggravated by prolonged activity.  Physical examination noted mild edema and tenderness to the ankle.  The pain was rated as minimal, but constant.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing use of the US Army Physical Disability Agency (USAPDA) Pain Policy.  The VA rated the left ankle condition 10%, coded 5010-5271 (Arthritis, due to trauma - limited motion of the ankle), citing moderate limited ankle motion.  The panel agreed that the ROM examinations proximate to separation detailed above were consistent with a moderate limitation of motion for the 10% rating.  All panel members agreed the limitation of motion was no more than moderate and therefore a higher rating of 20% was not indicated in the absence of marked limited ROM of the ankle.  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 left ankle condition, coded 5010-5271.  

Contended PEB Conditions:  Gastroesophageal Reflux Disease (GERD).  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 or implicated in the commander’s statement or judged to 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 chronic pain, left ankle condition, the panel unanimously recommends a disability rating of 10%, coded 5010-5271 IAW VASRD §4.71a.  In the matter of the contended GERD condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  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	
Chronic Pain, Left Ankle	5010-5271	10%	

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

AR20170012119, 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