RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00588
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “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 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 - 20060308	VARD - 20070111	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5099-5003	0%	Left Ankle Sprain	5271	10%	20061111	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Left Ankle Pain.  According to service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in February 2005 after he fell off stairs while deployed.  In October 2005 the CI underwent a stress examination under anesthesia with no instability found.  The CI was referred for consultation for an ankle brace.  X-rays and MRI were unremarkable.  

During the 10 January 2006 MEB examination (recorded on DD Forms 2807 and 2808) 4 months prior to separation, the CI reported left ankle pain.  Physical examination showed no erythema or edema. There was focal tenderness on the anterior inferior aspect of the medial malleolar area and also on the lateral malleolar area.  Pain was noted during dorsiflexion, plantar inversion and plantar eversion.  A drawer sign was positive, but reflexes and strength were normal.  Physical therapy measurements of the left ankle were dorsiflexion of 0 degrees (normal 20), plantar flexion 56 degrees (normal 45).
  
A podiatry MEB consultation dated 20 January 2006 was performed for the CI’s complaints of pain, tingling and numbness to the plantar aspect of the left foot after activity.  Examination revealed tenderness along the lateral and medial gutters.  There was no swelling, no edema and no heat.  There was tenderness with the ankle range of motion (ROM) measurements, which were full, with no crepitus or true pain of the ankle joint.  An anterior drawer or talar tilt of the left ankle was not appreciated.  The tarsal tunnel and ankle were unremarkable.  There were no abnormalities of tendons of the ankle and foot and no ankle effusions.  Anterior collateral ligaments appeared intact.  The 2 February 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic left ankle pain with recurrent sprains.  Physical examination, based on ROM measurements performed by physical therapy, showed ankle dorsiflexion of 0 degrees and plantar flexion of 56 degrees. 

At the 11 November 2006 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported left ankle pain and difficulty with prolonged standing and walking.  Physical examination of the left ankle showed signs of tenderness with no deformities. Dorsiflexion was 20 degrees and plantar flexion was 45 degrees with pain at the end of the motions.  Although there was pain and weakness with repetition, there was no loss of motion.  X-rays of the ankle showed no significant findings.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, coded 5099-5003 (arthritis, degenerative), citing subjective feelings of instability.  The VA rated the left ankle condition 10%, coded 5271 (ankle, limited motion of), citing objective tenderness and pain at the extremes of the ROM.

The panel considered whether the limitation of motion was moderate warranting a rating of 10% or marked warranting a 20% rating when considered under code 5271 (limitation of ankle motion).   The panel agreed that the ROM examinations proximate to separation detailed above were consistent with a moderate limitation of motion with 0 degrees of dorsiflexion on two examinations proximate to separation.  However, because plantar flexion on all examinations proximate to separation was within normal limits and there were reports of full ROM at the podiatry MEB consultation and VA examination, the panel agreed the left ankle condition did not rise to a marked level under code 5271.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and 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 5271.  

BOARD FINDINGS:  In the matter of the left ankle condition, the panel recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  There were 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	
Left Ankle Pain	5271	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170215, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180004711, 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