RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02247
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard or National Guard E4, Infantryman, medically separated for “chronic pain, left ankle…” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20050214	VARD - 20070713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Ankle…	5099-5003	10%	Postoperative Left Distal Fibula Fracture…History of Left Ankle Impingement…	5299-5271	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Ankle.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in February 2002 after a squad run.  Radiographic studies showed a left ankle fracture.  MRI in December 2003 showed scarring with thickening of the anterior talofibular ligament.  The CI underwent left ankle arthroscopic surgery in February 2004 that resulted in post-operative diagnosis of left ankle impingement and left ankle synovitis with debridement of a lateral ankle lesion.

Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left ankle pain…” for PEB adjudication.  

The MEB NARSUM examination on 5 January 2005, 3 months prior to separation, noted complaints of persistent ankle pain, swelling, popping and grinding, and decreased left ankle strength.  The physical examination showed 8 degrees of dorsiflexion and 25 degrees of plantar flexion with no pain and mild tenderness.  The CI was able to heel and toe walk, had normal vascular and neurological functioning, and motor function was intact.  The CI failed to report for the 11 June 2007 VA Compensation and Pension (C&P) evaluation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The Board considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  The ankle limitation of motion at the MEB examination demonstrated dorsiflexion of 8 degrees (normal =20), and plantar flexion to 25 degrees (normal45).  This would represent not greater than 50% reduction, consistent with moderate limitation.  The CI was not using an assistive device and he was able to heel and toe walk.  Therefore, Board members agreed, the higher rating of 20% was not justified under the 5271 code.  The Board found no other VARSD path to a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left ankle condition.  

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, 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 20150819, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004221, 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