RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX	CASE:  PD-2017-00665
BRANCH OF SERVICE:  AIr FORCE	SEPARATION DATE:  20050719

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Helicopter Maintenance Journeyman, medically separated for “right ankle pain” with a disability rating of 10%.  

CI CONTENTION:  Condition continues to worsen.  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 - 20050607	VARD - 20051102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5271-5299	10%	Right Ankle Lateral Ligament Reconstruction with Degenerative Changes	5015-5271	20%	20050712	
			Scar, Residual s/p Arthroscopy and Lateral Ligament Reconstruction	7804	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI underwent right ankle surgery in June 2004 for arthroscopic synovectomy and incision of meniscoid lesion.  The surgery did not offer any relief of the ankle pain and the CI underwent a reconstructive surgery in January 2005 with chondroplasty of the talar dome lesion and right ankle lateral ligament reconstruction.  

At the time of the physical therapy (PT) clinic appointment on 28 February 2005, 5 months prior to separation, the CI reported ankle pain rated 6/10.  Physical examination showed an antalgic gait, tenderness and swelling.  Range of motion (ROM) measurements showed a dorsiflexion of 6 degrees (normal 20) and a plantar flexion of 27 degrees (normal 45).  There was a positive anterior drawer and a positive talar tilt.  The CI continued to attend PT and on 28 March 2005, 4 months prior to separation, the CI reported ankle pain rated 2-3/10 with stiffness.  There was swelling at the subtalar joint, tenderness and limited ROM with a dorsiflexion of 4 degrees and a plantar flexion of 21 degrees.  At the 4 April 2005 orthopedic clinic appointment, the CI reported increased ankle pain.  The examiner noted that the CI had some residual swelling and was stable to anterior drawer and inversion stress.  There was joint line tenderness.  The CI received an ankle injection (Kenalog and Marcaine) and the examiner recommended no PT for three weeks to rest the ankle and then reinstitute PT.  

The 10 May 2005 MEB NARSUM, 2 months prior to separation, noted complaints of ankle pain rated 5-6/10.  The CI reported the ankle gave way on a regular basis.  Radiographic studies from 24 March 2005 showed generalized osteopenia in the hind foot and tarsal bones with bone spurring at the medial malleolus and navicular bones.  Physical examination showed mild right ankle swelling, decreased strength with dorsiflexion and an antalgic gait favoring his right leg.  Reflexes were normal.  Orthopedic consultation was summarized and noted as indicating that “prognosis is fair at best.”  The 14 June 2005 profile review continued the 6 April 2005 profile which included running, climbing, marching/walking restrictions, and stated “may wear crutches in uniform.”  

At the 12 July 2005 VA Compensation and Pension (C&P) examination, 1 week before separation, the CI reported right ankle pain rated 4/10 with flares to 10/10.  He was able to exercise on a stationary bicycle 30 to 45 minutes three times a week.  The CI used shoe orthotics.  Surgical history included right ankle arthroscopy with extensive debridement, right talar dome chondroplasty and drilling/microfracture, right tibiotalar exostosis resection, and right ankle lateral ligament reconstruction.  Physical examination showed the CI walked with a limp.  He had altered weight bearing so that weight bearing was displaced medially causing his right foot into a valgus deformity and flattening the arch.  Ankle jerk was absent and there was a well healed, 6 cm scar on the top of the right ankle joint which was painful to touch.  Dorsiflexion was recorded as “lacks 15 degrees of coming up to zero degrees, or in other words being at 90 degrees to the leg.”  Plantar flexion was normal at 45 degrees.  Painful motion was reported at the extreme of dorsiflexion.  The examiner reported that “with repetition as he has almost no ROM of the ankle joint, there is little lost.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5271 (limited motion of the ankle).  The VA rated the right ankle condition 20%, coded 5015-5271 (bones, new growths of, benign-limited motion of the ankle), citing marked limited motion of the ankle; and also rated 10% coded 7804 (scar), citing a painful scar.  

The panel does not recommend separation rating for scars unless their presence imposed a direct limitation on fitness.  The panel reviewed the STR and did not find evidence that a tender or painful scar separately interfered with duty, and therefore a separate rating was not recommended.  However, any disability from the tender scar was considered as combined with the rating of the unfitting right ankle condition.  The panel unanimously 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, based on the pre-separation PT and VA ROMs.  

The panel next considered whether a higher rating was supported under other diagnostic code options.  There was no ankylosis (5270), nonunion or malunion (5262) for rating under those codes.  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7), given that the talar dome and insertion of the reconstructed lateral ligament are part of the foot as well as the ankle.  Given the presence of an abnormal gait, abnormal weight bearing, swelling, weakness, tender scar and painful marked limitation of ankle motion with functional loss, the panel majority agreed the impairment more nearly approximated the “severe” disability picture to support a 30% rating under code 5284.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 30% for the right ankle condition, coded 5271-5284.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel majority recommends a disability rating of 30%, coded 5271-5284 IAW VASRD §4.71a.  The single voter for dissent submitted the appended minority opinion.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Ankle Pain	5271-5284	30%	

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear Applicant:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00665.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.