RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00713
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20040716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic pain/instability left ankle” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  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 - 20040604	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain/Instability Rated as Slight/Occasional	5009-5003	0%	No VA Exam Proximate to Separation in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain/Instability.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in October 1999 following a road march without specific injury.  The record then falls silent until the CI was seen on 9 June 2003 in primary care.  He reported an acute sprain.  A 30 June 2003 X-ray was remarkable for early degenerative joint disease (DJD) without evidence of a fracture.  Magnetic Resonance Imaging (MRI) showed probable tears of two of the lateral ankle ligaments (anterior talo-fibular and calcaneofibular).  No loose fragments (bone or cartilage) were observed.  The CI was noted to have instability consistent with the ligamentous injuries observed in the MRI and was treated conservatively with duty limitations, bracing, a cast boot, and medications.  These proved unsuccessful and the CI was unable to return to full duty.  Surgery was recommended but declined by the CI due to the length of recovery and the fact that there was no guarantee that he would improve sufficiently to return to full duty status.  The decision to decline surgery was thought to be reasonable by the treating podiatrist.  

During the 2 February 2004 MEB NARSUM examination, 5 months prior to separation, the CI reported chronic left foot and ankle pain.  Physical examination showed pain with stability testing and tenderness to the ligaments.  Sensation was normal and there was no swelling or signs of acute injury.  Instability was diagnosed, but not documented on the examination.  On 25 May 2004 the same podiatrist again evaluated the CI who reported frequent ankle sprains and difficulty walking on uneven ground.  Swelling was present and the ligaments were again tender and painful with stability testing.  One test for instability was positive.  The range of motion (ROM) was not documented on either examination nor found in the outpatient records in the year prior to separation.  The gait was not recorded.  There VA examination in evidence was too remote from separation to be probative for rating at separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The panel noted this policy has since been rescinded and its recommendations were based on the VASRD in effect at the time of separation.  The panel agreed there was no documented limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However, the panel concurred that a 10% rating for functional loss (§4.40, §4.45) due to instability and (implied) pain with motion was supported by the evidence of record.  The panel considered alternative ankle and analogous VASRD codes, but all were less applicable and not advantageous to rating.  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 left ankle condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left ankle condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a, §4.40, §4.45.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends 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/Instability Left Ankle	5099-5003	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20160911, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170017454, 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