RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00980
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “chronic pain left ankle pain” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  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 - 20040423	VARD - 20040826	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Ankle Pain	5099-5003	0%	Recurrent Left Ankle Sprain Status Post Distal Fibula Fracture	5099-5020	10%	20040316	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began in April 2003 after twisting it on the confidence course.  Radiographic studies showed “large soft tissue swelling medial ankle joint probably deltoid ligament tear and short oblique spiral fracture lateral malleolus above joint line.”  His left ankle fracture was casted then removed in late May 2003, but despite therapy the CI was unable to tolerate running or return to training.  At the 3 February 2004 family practice consult the examiner recorded the CI had left ankle pain and swelling with standing or running.  On examination there was widespread tenderness and some swelling about the left ankle.  However, he was noted to have full active range of motion (ROM) though actual measurements were not provided.
The 17 February 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of left ankle pain and swelling with increased activity.  Physical examination showed widespread tenderness and mild swelling, but the CI could “heel and toe stand and walking [was] good.”  Ankle ROM was full, 70 degrees (normal 65) in both ankles.  On 10 December 2003, left ankle X-rays performed showed a healed or nearly healed fracture of the distal fibula.  

At the 16 March 2004 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported pain and swelling with prolonged walking or running.  Physical examination showed a normal gait, but tenderness and swelling on the side of the left ankle.  Left ankle ROM was 20 degrees of dorsiflexion and 45 degrees of plantar flexion with pain in both planes of motion.  The examiner noted ROM on the left was additionally limited by pain, but did not quantify the additional limitation.  The examiner also noted the left ankle was not additionally limited by fatigue, weakness, lack of endurance or incoordination.  Radiographic studies of the left tibia/fibula showed the bones, joints and soft tissues were “unremarkable.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing slight and intermittent pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the left ankle condition 10%, coded 5099-5020 (analogous to synovitis), citing persistent ligament and joint damage resulting in painful ankle motion.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However at the pre-separation VA examination there was evidence of painful motion causing functional loss supporting the 10% rating for painful motion coded either under 5003 or 5271 (based on §4.59, §4.40 and §4.45).  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or 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.  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 Left Ankle Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160921, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018916, 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