RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00895
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CW2, AH-64 Pilot, medically separated for “right ankle pain with history of injury” with a disability rating of 10%.  

CI CONTENTION:  The ankle injuries severely affect and limit many aspects of his life beyond the 10% rating from the army.  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 - 20031007	VARD - 20040117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain with History of Injury 	5271	10%	Postoperative Residuals, Right Ankle Fracture	5299-5271	10%	20031006	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right ankle surgery in May 2002 for a fracture (distal tibial and talar dome) sustained after jumping into shallow waters.  At the 3 June 2003 orthopedic visit, the CI reported being “able to feel the screw.”  Range of motion (ROM) measurements showed 10 degrees of dorsiflexion (normal 30) and 10 degrees of plantarflexion (normal 45).  

During the July 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported chronic ankle pain, with inability to run without pain.  Physical examination showed limited ROM and tenderness over the ankle without swelling.  Radiographic evaluation in August 2003 revealed normal alignment and healing with no evidence of hardware fracture or loosening; and osteochondral defects (cartilaginous and bony degeneration) of the ankle (distal tibia and talar bone).  

The 20 August 2003 MEB NARSUM examination, 5 months prior to separation, noted reports of pain with decreased ROM with inability to run even short distances, walk moderately long distances, jump, bear excessive weight, or mount/dismount military tactical vehicles.  Physical examination revealed tenderness at the medial ankle and distal tibia.  There was an antalgic gait that became more prominent with running.  ROM measurements showed dorsiflexion to 10 degrees (normal 20) with discomfort and plantar flexion to 10 degrees (normal 45).  

At the 6 October 2003 VA Compensation and Pension (C&P) evaluation, 3 months before separation, the CI reported constant pain and swelling after long days on his feet.  He reported an inability to walk for more than 30 minutes; run, jump or walk on uneven ground; and carry excessive weight and mount/dismount military tactical vehicles.  Physical examination showed tenderness of the medial ankle and distal tibia, an antalgic gait, dorsiflexion to 0 degrees and plantarflexion to 25 degrees.  After five repetitions, dorsiflexion increased to 2 degrees and plantar flexion to 28 degrees; with increased pain, weakness and fatigue.  

At a June 2004 orthopedic visit, the physical examination showed “a few degrees of full dorsiflexion and [was lacking] approximately 20 degrees of full plantar flexion” with pain on forced dorsiflexion.  In October 2004, the CI underwent arthroscopic debridement with spur excision and was noted to have chondromalacia (degenerative arthritis).  At a 4 November 2005 orthopedic clinic appointment, the examiner noted the continued ankle pain was due to post-traumatic osteoarthritis consistent with the CI’s injury.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the right ankle condition, coded 5271 (ankle, limited motion of, moderate), citing fracture, surgery and limited ROM.  The VA rated 10% for the “postoperative residuals, right ankle fracture” condition, analogously coded 5299-5271 (ankle, limited motion of, moderate), based on the C&P examination 3 months before separation, citing limited ROM with pain on repetitive use.  A second VARD dated 11 January 2005 was completed due to additional evidence received by the VA.  The 10% rating was increased to 20%, coded 5003-5271 (arthritis, degenerative osteoarthritis; ankle, limited motion of, moderate), effective 30 January 2004 citing marked limitation of motion.  

The panel considered if the limitation of motion was ‘moderate’ or ‘marked’ when considered under 5271.  The panel agreed the ROM examinations proximate to separation detailed above were consistent with a ‘marked’ limitation of motion supported by the presence of an antalgic gait for the 20% rating under this code.  Because there was no ankylosis (5270), nonunion or malunion (5262), VASRD §4.71a offers no applicable joint code which would yield a higher rating.  The panel also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7), but panel members agreed the ankle impairment could not be characterized as “severe” to support the next higher rating coded as 5284.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the “right ankle pain with history of injury” condition, coded 5010-5271.  

BOARD FINDINGS:  In the matter of the right ankle pain with history of injury condition, the panel majority recommends a disability rating of 20%, coded 5003-5271 IAW VASRD §4.71a.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  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	
Right Ankle Pain with History of Injury	5010-5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018117, 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