RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00068
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Aviation Operations Specialist, medically separated for “chronic pain, left ankle,” with a disability rating of 10%.

CI CONTENTION:  “Resubmission as per letter from PDBR; I was discharged after a year with a 0% disability rating due to an injury incurred during my training that made me unable to complete my physical exams.”  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 – 20060612	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Ankle	5099-5003	0%	No VA Examination in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

Chronic Pain, Left Ankle.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in March 2006 when she tripped and fell while running.  The clinical record, NARSUM, Physical Profile and MEB report clearly and consistently documented that a right ankle condition was the diagnosis, though the panel noted the PEB Report (DA Form 199) listed “chronic pain, left ankle” (emphasis added) as the unfitting condition, presumably in error.  The panel undertook to perform analysis of the right ankle condition.  Radiographic studies performed immediately after the injury were negative for acute fracture (a bone fracture due to quick trauma rather than a stress fracture over time).  Evaluation by Orthopedics concluded with a diagnosis of right ankle sprain. 

At the 19 May 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month prior to separation, the examiner reported that the right ankle was tender, had “weight bearing active motion.  Active motion was decreased.  Active motion was hypermobile to dorsiflexion.”  Reflexes were reported as normal.  The physical therapy examination 1 week later (25 May 2006) recorded ROM of the left ankle as dorsiflexion of 0 (normal 20) and plantar flexion of 40 degrees (normal 45).  The examination recorded no ROM measurements for the right ankle.  The MEB NARSUM on 7 June 2006, 2 weeks prior to separation, noted complaints of continued pain with running.  Physical examination was unremarkable other than pain of the right ankle apparent to examination by touch and gait that was recorded as “atatic” (ataxic gait is uncoordinated or clumsy).  The clinical record, NARSUM, Physical Profile and MEB report clearly and consistently documented that a right ankle condition was the diagnosis, though the panel noted the PEB Report (DA Form 199) listed “chronic pain, left ankle” (emphasis added) as the unfitting condition, presumably in error.  There was no VA examination in evidence proximate to separation.

The panel directed attention to a rating recommendation for the right ankle condition.  The PEB rated the left ankle condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) Pain Policy, which rated the injury as slight and intermittent with running, jumping and walking over one mile.  The PT examination, interpreted as being performed on the right ankle, recorded loss of dorsiflexion and near normal plantar flexion, which supported a 10% rating for moderate limitation of motion (5271 ankle, limited motion) when also considering the abnormal gait reported at the NARSUM examination.  A higher rating of 20% was not indicated in the absence of marked limited ROM of the ankles.  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 chronic pain, right ankle, coded 5271.  

BOARD FINDINGS:  In the matter of the chronic pain, right ankle, the panel unanimously recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  There were 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, Right Ankle	5271	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160115, w/atchs
Exhibit B.  Service Treatment Record

	

AR20170013278, 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