RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01106
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040423

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Information Systems Operations Analyst, medically separated for “instability and pain right ankle” with a disability rating of 10%.  

CI CONTENTION:  He had other medical conditions that were overlooked by the PEB which were unfitting, including a lumbosacral strain resulting in degenerative arthritis and radiculopathy, and a cervical strain resulting in degenerative disc disease.  His right ankle injury has caused him to favor his left leg, resulting in pain in his left knee.  All these injuries significantly impact his activities and abilities and he should have been rated higher than 10%.  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 - 20031217	VARD - 20040322	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Instability and Pain Right Ankle	5271	10%	Right Ankle Fracture, Postoperative	5271	10%	20040123	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Instability and Pain Right Ankle.  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 2002 after slipping on ice.  Radiographic studies showed a maisonneuve fracture of the right ankle, and right ankle syndesmosis screw fixation surgery was performed on 20 December 2002.  The hardware was removed in April 2003 and he deployed soon after but was unable to perform his duties and was medically evacuated back to Germany.  At the time of the 1 July 2003 orthopedic clinic appointment (10 months before separation), the examiner opined the CI required revision surgery and recommended an arthroscopy to debride the scar and revise syndesmosis screw placement to a more anatomical position.  X-ray studies in August 2003 showed a stable right ankle with soft tissue swelling but no evidence of delayed osseous union or new fracture/dislocation.  The X-rays did show a persistent fracture of the mid shaft of the fibula distally.  Magnetic resonance imaging (MRI) conducted in September revealed no bone bruises or osteochondral injuries but did show an abnormal appearance of the deltoid ligament likely representing chronic disruption, and changes suggestive of tenosynovitis of the extensor digitorum longus tendon.  The CI opted not to have further surgery due to his impending separation, preferring to wait until after he left the Army.  The 3 October 2003 MEB NARSUM examination, 7 months prior to separation, noted complaints of pain in both the medial and lateral aspects of the right ankle and between his first and second metatarsal; and ankle instability, especially with running over uneven terrain.  Physical examination showed moderate tenderness to palpation over the deltoid ligament, posterior tibial tendon, and anterior talofibular ligament.  Right ankle range of motion (ROM) showed dorsiflexion of 0 degrees (normal 20) and plantar flexion of 30 degrees (normal 45).  Pain with motion was noted with resisted inversion.  

At the 23 January 2004 VA Compensation and Pension (C&P) evaluation, 3 months before separation, the CI reported he could only walk for 10 minutes before experiencing pain.  Physical examination showed normal gait and posture.  He had slight discoloration in the dependent aspect of his right foot, and an 3x8cm area of numbness on the lateral dorsal aspect.  Right ankle ROM following repetition and measured with a goniometer showed dorsiflexion of 0 degrees (normal 20) and plantar flexion of 30 degrees (normal 45), with pain noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (ankle, limited motion of:  moderate), citing moderate limitation of motion.  The VA also rated the right ankle condition 10%, coded 5271 (ankle, limited motion of:  moderate), based on the C&P examination 3 months before separation, citing decreased range of motion with pain on motion.  The panel agreed that the ROM evidence was more reasonably characterized as “marked” limitation of motion consistent with the 20% rating under diagnostic code 5271.  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 the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  However, all panel members agreed that the impairment did not more nearly approximate “severe” to support a 30% rating under this code.  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 condition, coded 5271.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel unanimously recommends a disability rating of 20%, coded 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	
Instability and Pain Right Ankle	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160929, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment 

AR20170018128, 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