RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00628
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Motor Transport Operator, medically separated for “chronic right ankle pain” with a disability rating of 20%.  

CI CONTENTION:  Current condition supports a higher rating.  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 - 20051020	VARD - 20060905	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5099-5003	20%	S/P Surgery, Right Ankle	5271	10%	Treatment Records	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was first seen for his right ankle on 12 November 2004.  He reported an injury 2 weeks earlier and aggravation that day during a run.  An X-ray showed an old un-united chip fracture as well as an incidental os trigonum of the heel (a congenital non-fusion of part of the bone).  He was thought to have os trigonum syndrome (an entrapment of one of the tendons of the foot) and placed in a walking boot (cam walker).  He was also referred to physical therapy.  During a road march on 1 December 2004 he reinjured his ankle and was placed on crutches.  Despite non-surgical treatment, he remained symptomatic and had surgery for the os trigonum syndrome on 19 April 2005.  He was subsequently entered into the MEB process.  

During the 22 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported constant foot pain since the surgery.  The CI wore a soft ankle brace.  The range of motion (ROM) was noted to be reduced, but it was not recorded.  The ROM done in physical therapy 2 weeks earlier showed dorsiflexion (toes up) of 10 degrees (normal 20) and plantar flexion of 10 degrees (normal 45).  The MEB NARSUM was the same day as the DD Form 2807-1 and 2808 examination which it referenced.  A bone scan on 19 August 2005 was normal.  It was done specifically for back pain, but examined the entire skeleton.  In orthopedics on 6 September 2005, the CI reported ongoing pain and was unable to walk or run.  The ankle was noted to be well healed with limited dorsiflexion at 5 degrees.  Motion was otherwise normal.  There was no VA examination proximate to separation in evidence.  The VA rating decision did note dorsiflexion was limited to 12 degrees on an undated VA treatment encounter.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, analogously coded 5099-5003 (degenerative arthritis), citing application of the US Army Physical Disability Agency pain policy.  The VA rated the right ankle condition 10%, coded 5271 (limited motion of the ankle), based on the VA treatment note as recorded above.  The panel noted that code 5271 was a better description for the clinical condition; however, a maximum of 20% is available under this code, providing no advantage to the CI.  After due deliberation, considering all of 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 20170214, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006533, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX 

	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