RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00984
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “chronic right 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 - 20031006	VARD - 20040621	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5024	0%	Chronic Tendinosis of the Peroneal Tendons	5024-5271	0%*	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	
* VA changed rating to 10% effective 20040110 based on examination dated 20050125.  

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in December 1999 after twisting it playing basketball.  An X-ray performed on 5 June 2003 revealed no evidence of acute fracture or dislocation, but there was a small ossicle at the base of the medial malleolus (ankle).  Diagnostic imaging (CT scan and MRI) showed some evidence of impingement at the tibiotalar joint and evidence of thickening of the peroneal tendons, but no evidence of frank rupture.  The medial flexors were intact.  

At the 6 June 2003 orthopedic clinic appointment, 7 months prior to separation, the CI reported persistent pain in his ankle, worse with running, prolonged standing and any change in the weather.  He also stated that his ankle rolled frequently and anytime he was on an uneven surface.  The CI declined offered surgery.  On examination, there was ankle range of motion (ROM) of dorsiflexion of 10 degrees (normal 20 degrees) and plantar flexion of 45 degrees (normal 45 degrees), with pain at the extreme ends of flexion in the posterior aspect.  The CI was able to heel/toe walk.  There was tenderness to palpation (TTP) posterolaterally and in the anterior inferior deltoid ligament.  There was mild increase in prominence around the medial and lateral malleolus; and strength testing was 5/5 (normal) in the extensor and tibialis anterior, with 4+/5 (slight weakness) in the tibialis posterior and peroneals.  

The 27 August 2003 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic ankle pain, with severe pain at any attempt to run, walk on uneven ground, jump, perform sports or do other physical activities.  In his duty as a truck driver, simply getting in and out of trucks had become impossible due to his pain.  Physical examination showed ankle ROM with dorsiflexion of 5 degrees (normal 20 degrees) and plantar flexion of 35 degrees (normal 45 degrees), with no mention of pain with motion documented.  Anterior drawer testing revealed no sign of ankle instability, but there was fullness just beneath the lateral malleolus and TTP along the course of the peroneal tendon.  Motor strength was 5/5, and the CI was able to toe walk and heel rise.  MRI was reported as indicating chronic changes of tendinosis of the peroneal tendon.  

At the 25 January 2005 VA Compensation and Pension (C&P) evaluation, 13 months after separation, the CI reported right ankle weakness, stiffness, increased laxity, and swelling.  He used a lace-up ankle brace.  Physical examination showed obvious swelling in the peroneal tendon, TTP and pain with inversion.  There was 1+ lateral laxity, and “somewhat weak” on eversion.  The CI was able to toe and heel walk.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right ankle pain condition 0%, coded 5024 (tenosynovitis), citing no loss of motion or evidence of joint instability (with possible application of AR 635-40, B-29 for rating only mechanically limited ROM).  The VA initially rated the “chronic tendinosis of the peroneal tendons” condition 0%, coded 5024-5271 (tenosynovitis analogous to ankle, limited motion of), citing failure to report for a VA examination and no evidence of moderated limited motion.  The VA retroactively increased that rating to 10% citing swelling on examination.  

The panel agreed that the orthopedic and NARSUM examinations (dorsiflexion of 10 degrees with pain, and 5 degrees respectively) proximate to separation had the highest probative value for rating at separation.  There was clear limitation of motion and the panel agreed that the ROM examinations proximate to separation were consistent with the “moderate” limitation of motion required for the 10% rating under this code, and were supported by the presence of swelling and evidence of tendinosis.  A higher rating of 20% was not indicated in the absence of “marked” limited ROM of the ankle.  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 5024-5271.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel unanimously recommends a disability rating of 10%, coded 5024-5271 IAW VASRD §4.71a.  There are 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 Right Ankle Pain	5024-5271	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160917, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170018521, 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