RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00531
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20090630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Cannon Crewmember, medically separated for “chronic left ankle pain and limitation of motion” with a disability rating of 10%.   

CI CONTENTION:  “Review all conditions.”  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 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’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation 

RATING COMPARISON:  

SERVICE PEB - 20090528	VARD - 20091014	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain and Limitation of Motion	5271	10%	Osteochondral Defect, Left Ankle, S/P Microfracture with Chronic Pain	5271	20%	20090905	
Bilateral Hearing Loss	Not Unfitting 	No VA Exam in Evidence	
Lumbar Back Pain	Not Unfitting 	Lumbar Strain	5237	20%	20090905	
Cervical Neck Pain	Not Unfitting 	Cervical Strain	5237	10%	20090905	
Bilateral Knee Pain	
Not Unfitting 	Chondromalacia Patella, Left Knee	5299-5257	10%	20090905	
		Chondromalacia Patella, Right Knee	5299-5257	10%	20090905	
GERD	Not Unfitting 	GERD	7346	0%	20090903	
Insomnia	Not Unfitting 	No VA Exam in Evidence	
Tinea Cruris	Not Unfitting 	Tinea Cruris/Pedis	7813	NSC	20090905	
Tinea Pedis	Not Unfitting 					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY: 

Chronic Left Ankle Pain and Limitation of Motion.  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his left ankle in August 2008.  Magnetic resonance imaging (MRI) on 14 August 2008, and a computerized tomography (CT) scan on 16 October 2008, revealed osteochondritis dissecans (OCD) involving the medial talar dome.  The CI underwent arthroscopic debridement of the lesion on 10 December 2008, however, he continued to have pain despite splinting, casting and post-operative rehabilitation therapy. On 29 January 2009, X-rays revealed no compelling evidence of the previously identified OCD, and orthopedic range of motion (ROM) measurements the same day showed dorsiflexion to “neutral” and plantar flexion to 40 degrees (normal 45). 

At a 5 February 2009 physical therapy (PT) visit, ROM was dorsiflexion of 5 degrees and plantar flexion of 15 degrees.  Left ankle X-rays on 3 March 2009 showed no abnormalities, and a 10 March 2009 PT evaluation showed dorsiflexion of 5 degrees and plantar flexion of 35 degrees.  The examiner noted a mild effusion but normal muscle strength. 

The 24 March 2009 MEB NARSUM podiatry examination, 3 months prior to separation, noted continued CI complaints of pain after surgery, rated as high as 8/10.  Physical examination revealed a normal gait, ankle ROM, and lower extremity muscle strength.  The CI experienced aching with full weight bearing, and the examiner commented that his weight was likely a factor.  During the 8 May 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months before separation, the CI reported chronic left ankle OCD that “affects use of left foot.”  The examiner noted left ankle pain at the medial malleolus, decreased ROM, and no instability.  At the 8 May 2009 MEB NARSUM examination, the CI reported left ankle pain rated 4/10 at rest, which worsened with walking, climbing stairs, and standing for prolonged periods.  Physical examination revealed an antalgic gait, use of a controlled ankle motion boot, and left ankle tenderness and pain along the medial malleolus.  Dorsiflexion was 7 degrees and plantar flexion was 20 degrees after repetition, and limited by pain.

At the 5 September 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported chronic left ankle swelling, pain, and giving way which limited walking to only 50 yards.  Physical examination showed a very noticeable left lower extremity limp, however, the he did not use a brace or ambulatory aids.  There was generalized left ankle tenderness and mild swelling with synovial thickening.  Strength was 4/5 with pain elicited during muscle testing.  Measured ROM was dorsiflexion to 0 degrees and plantar flexion to 40 degrees with the examiner noting the CI “did not appear to be giving a maximum effort.” 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5271 (limited motion of the ankle), citing moderate limitation of motion.  The VA rated the left ankle condition 20%, also coded 5271, based on the C&P examination, citing that while a 10% rating is generally assigned for moderate limitation of motion, evidence showed additional symptoms consistent with a higher evaluation.  The panel agreed that the PT, NARSUM and VA ROM examinations proximate to separation were consistent with the “marked” limitation of motion required for the maximum 20% rating under code 5271 for dorsiflexion measurements of 5 degrees, 7 degrees, and 0 degrees.  The panel also considered whether VASRD code 5284 (other foot injuries) provided for a higher rating IAW VASRD §4.7, but agreed that the impairment did not more nearly approximate “severe” for a 30% rating.  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 chronic left ankle pain and limitation of motion condition, coded 5271. 

Contended PEB Conditions:  Bilateral Hearing Loss, Lumbar Back Pain, Cervical Neck Pain, Bilateral Knee Pain, GERD, Insomnia, Tinea Cruris and Tinea Pedis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions; and so, no additional disability ratings are recommended. 

BOARD FINDINGS:  In the matter of the left ankle condition, the panel recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  In the matter of the contended bilateral hearing loss, lumbar back pain, cervical neck pain, bilateral knee pain, GERD, insomnia, tinea cruris and tinea pedis conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 Ankle Pain and Limitation of Motion 	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170214, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180007409, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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