RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00409
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090127

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

CI CONTENTION:  “Awarded disability, 30% wasn’t paid from time of medical discharge.  Being prorated due back pay of loan during reserve time, this is incorrect…”  The rest of the CI’s contention mentioned conditions not identified by either the Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB).  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 - 20081208	VARD - 20110805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain…	5099-5003	10%	Left Ankle Injury	5271	0%	20101207	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in sometime around age 13 when he knew that he had flat feet.  He was able to graduate from both initial entry and advanced individual training while sustaining several ankle sprains during each training period.  In August 2007 he accessed to the active component and began having foot/ankle problems during his first unit run at Fort Hood, Texas.  He was seen in the Emergency Room and X-rays revealed abnormalities to include some degenerative changes and a possible tarsal coalition with pes planus.  He was seen by podiatry and prescribed orthotic inserts.  The podiatrist also offered surgery but the CI declined.  He deployed in October 2007 and immediately began having problems with his foot/ankle walking over uneven terrain.  After several more ankle sprains he was seen in sick call in December 2007 and was again referred to a podiatrist in theater.  The CI was profiled and sent back to Fort Hood in June 2008 to begin the MEB process.  An 9 September 2007 magnetic resonance imaging (MRI) showed edema in the middle portion of the navicular bone with a small focus of coracoid irregularity on the proximal surface, measured as 3mm.  X-rays done a year later in September 2008 demonstrated normal bony ossification, alignment and joint spacing.  There was no evident fracture, dislocation or osseous lesion.  There was a suggestion of pes planus on the study.  The 14 November 2008 MEB NARSUM, 2 months prior to separation, noted that the CI still was unable to run or pass the alternate walking physical fitness test.  The physical examination noted the CI had a normal gait.  The examiner noted that he had “severe bilateral pes planus.”  Sensation in the lower extremity was normal.  The left ankle had tenderness to palpation on the lateral malleolus.  There was normal pulses and no swelling or edema.  He was able to walk on his heels and his toes.  His left ankle range of motion (ROM) had ankle dorsiflexion of 40 degrees (normal 20) and a plantar flexion of 30 degrees (normal 45).  Painful motion was not addressed.  There was no VA examination in evidence proximate to separation.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle pain condition 10%, coded analogously as 5003 (degenerative arthritis), citing painful motion.  All panel members agreed there was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  There was no ankle ankylosis to support a rating coded 5270.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  There was no evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45).  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 left ankle condition.  

BOARD FINDINGS:  In the matter of the left 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 20160616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015549, XXXXXXXXXXXXXXXXXX. 

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