RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00649
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20050511

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Infantryman, medically separated for “right ankle pain following Achilles tendon rupture” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20050322	VARD - 20051020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5024	10%	Residual Scar…Right Achilles Tendon	5299-5284	0%	20050822	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a right Achilles tendon (AT) reconstruction in July 2003 after a complete rupture occurred during a unit run.  Following surgery, the CI continued to report ankle pain with activity.  At the 16 February 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported he was unable to continue being an infantryman due to his past right AT injury.  Physical examination noted “diminished” right foot flexion and extension due to discomfort.  

During the 3 March 2005 MEB NARSUM examination, 2 months prior to separation, the CI reported continued limiting pain over the AT repair with the inability to run, march or stand for prolonged periods.  Physical examination revealed right ankle dorsiflexion (DF) to 20 degrees (the examiner indicated this was 15 degrees less than the left ankle) and there was full plantar flexion bilaterally; painful motion was not addressed.  Sensation and pulses were normal. 

At the VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported right ankle pain, with weakness, stiffness and fatigue with standing or walking.  He had not lost any time from work due to the condition.  Physical examination revealed normal gait and posture.  The CI was not using a cane or a crutch for ambulation.  There was no tenderness, weakness, swelling or muscle atrophy.  The surgical scar was tender with disfigurement, with tissue loss of less than six square inches, without ulceration or adherence.  The right AT was in good alignment.  There was pes planus without valgus deformity or forefoot/midfoot malalignment.  There was no tenderness to palpation of the bottom of the foot.  Right ankle dorsiflexion was 20 degrees (normal) and plantar flexion was 45 (normal); painful motion was not addressed.  After repetitive range of motion (ROM) the function of the joint was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination.  The VA examiner noted that the CI did not have any limitation with standing or walking.  The examiner diagnosed a slight irregular right AT scar without other objective findings.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5024 (tenosynovitis), citing loss of joint motion.  The VA rated the right ankle condition 0%, analogously coded 5299-5284 (foot, injuries other), based on the C&P evaluation.  

Prior to separation there was evidence of painful limited ankle ROM documented on the MEB Form 2808 examination to support a 10% rating based on VASRD §4.59 (painful motion).  The limitation of ankle motion described by the MEB NARSUM examiner (DF of 20 degrees that was less than the left) was slight and did not approach the “moderate” stipulation required for a 10% rating under 5271 (limited motion).  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  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 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180004727, 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