RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00587
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Food Service Specialist, medically separated for “chronic pain in right ankle” with a disability rating of 0%.  

CI CONTENTION:  The CI contends that his condition has worsened since last rating decision.  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 - 20041112	VARD - 20060911	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Ankle	5099-5003	0%	Right Ankle Pain	5271	10%	20060510	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Ankle Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right ankle condition began in January 2004 after falling from a five-ton truck.  At a 6 August 2004 physical therapy visit, 6 months prior to separation, range of motion (ROM) measurements showed 10 degrees of dorsiflexion (normal 20) and 40 degrees of plantar flexion (normal 45).  Pain was noted with inversion and eversion movements.  The CI was noted to be “ambulating well” that day.  

The 15 August 2004 MEB NARSUM examination noted complaints of pain with flare ups that occurred 2 to 3 times per week, with worsening after prolonged standing and walking.  Physical examination showed a “normal, slow gait” with plantar flexion of 40 degrees and dorsiflexion of 10 degrees.  

At the 10 May 2006 VA Compensation and Pension (C&P) evaluation, performed 16 months after separation, the CI reported discomfort in the right ankle.  Physical examination showed the CI was able to walk and stay in a standing position without restrictions.  Plantar flexion was to 40 degrees and dorsiflexion was to 8 degrees with painful motion.  There were no additional limitations after repetition.  Radiographic evaluation reportedly showed lateral soft tissue edema without evidence of fracture, deformity, or arthritic changes.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the right ankle 0%, analogously coded 5099-5003 (degenerative arthritis), citing that the condition was rated IAW the US Army Physical Disability Agency’s pain policy for slight/intermittent pain.  The VA rated the right ankle condition 10%, coded 5271 (ankle, limitation of motion), based on the C&P examination 16 months after separation, citing moderate limitation of motion.  

Panel members agreed the limitation of motion was no more than moderate, therefore supporting the 10% rating under code 5271.  A higher rating of 20% was not warranted in the absence of marked limited ROM of the ankle.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than 10%.  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 right ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the chronic right ankle condition, 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 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016274, 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 Affair.

Sincerely,	
Enclosure