RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02450
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Trainee, medically separated for “right ankle joint pain with bone bruising” with a 0%.  

CI CONTENTION:  “Ongoing pain in right ankle.”  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 - 20061026	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Joint Pain…	5099-5003	0%	No VA Examination in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Right Ankle Joint Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in May 2006 after he suffered an inversion injury while carrying another Soldier in a fireman carry.  MRI study on 26 June 2006 showed mild osseous bruising involving the medial malleolus and talar dome regions.  There was no evidence of tendon damage surrounding the ankle and no evidence of intraarticular effusion.  A physical therapy clinic examination on 24 August 2006 (2 months prior to separation) showed normal, pain free range of motion (ROM) with tenderness to palpation about the right ankle.  There was no swelling or redness and no instability was noted.  A podiatry clinic examination on 13 September 2006 (2 months prior to separation) showed tenderness to palpation and decreased sensation down the right metatarsal, calcaneal and anterior ankle areas. The fibular area was not tender to palpation.  A magnetic resonance imaging (MRI) study showed the mid-malleolar area and the talar dome had mild osseous bruising.  Despite treatment, the ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “diffuse right ankle joint pain and bone bruising secondary to a right ankle inversion trauma sustained during training” for PEB adjudication.  

The MEB NARSUM examination on 13 September 2006, 2 months prior to separation, noted complaints of pain (4 out of 10) with morning stiffness and numbness to the dorsal aspect of the right mid-foot.  The CI could wear a boot.  The physical examination showed tenderness to palpation was noted at the right anterior tibia and medial malleolus and medial calcaneal area. The CI exhibited pain on ankle joint ROM.  There was no tenderness to palpation on the right fibula and the lower extremities were neurovascularly intact.  No crepitus was noted.  The examiner noted that the CI went to his toes when going to stance to avoid bearing weight on the heel of his foot.  

There was no evidence in the record of the CI making a claim for disability compensation with the Veterans Administration (VA).  The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle joint pain 0%, analogously coded 5099-5003 (arthritis, degenerative), citing loss of plantar flexion as pain-limited and not a mechanical block, without significant loss of ROM.  The Board noted subjective reports of pain with use, objective findings of tenderness to palpation and painful motion, and radiographic evidence of bruising of the bone.  Board members agreed that the evidence supports 10% rating for painful motion and functional loss IAW §4.40 (Functional loss). After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right ankle pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the right ankle pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board 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	
Right Ankle Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151012, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004627, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

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