RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2016-01793
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20041209

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic pain, right ankle, following two surgical procedures” with a disability rating of 20%.

CI CONTENTION:  The condition continues to worsen.  The complete submission is 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 Medical Evaluation Board (MEB), but determined by the PEB 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. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20041012	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Ankle	5271	20%	Chronic Right Ankle Pain Status Post Talar Exostectomy, Nerve Release	5273-5271	20%	STR	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Right Ankle Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI twisted his right ankle during a march in January 2003, and X-rays revealed an exostosis on the dorsal aspect of the right talus. He underwent surgeries in April 2003 and February 2004 for excision of the exostosis and a nerve entrapment release.

The 7 August 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of slight, intermittent pain right ankle pain. Physical examination showed right ankle range of motion (ROM) in all planes at less than 10 degrees. Ankle X-rays showed no fracture or exostosis. The 12 October 2004 MEB physical therapy ROM study showed right ankle dorsiflexion of 4 degrees (normal 20 degrees) and plantar flexion of 10 degrees (normal 45 degrees). There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition 20%, coded 5271 (ankle, limited motion of), citing marked limitation of motion.  The VA also rated the right ankle condition 20%, but dual coded 5273-5271

(os calcis or astragalus, malunion of-ankle, limited motion of), based on the STR. Panel members agreed that the ROM examinations proximate to separation were consistent with the “marked” limitation of motion required for the maximum 20% rating under code 5271. There was no evidence of ankylosis, nonunion or malunion for a higher rating under VASRD §4.71a. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right ankle condition.

BOARD FINDINGS: In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends no modification or re- characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20161115, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20200000367, 

Dear XXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      

Enclosure

2	PD-2016-01793