RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00721
BRANCH OF SERVICE:  AIR fORCE	SEPARATION DATE:  20090526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Technical Applications Specialist, medically separated for “chronic right ankle due to osteochondral dessicans lesion of talus” with a disability rating of 10%.   

CI CONTENTION:  “Conditions cause daily impairment of normal activities.”  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 FPEB - 20081124	VARD - 20090818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle due to Osteochondral Dessicans Lesion of Talus	5284	10%	Osteochondritis of the Right Ankle…	5271	10%	20080408	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Ankle due to Osteochondral Dessicans (OCD) Lesion of Talus.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic right ankle condition began in June 2007 after he twisted his ankle.  Following the injury, the CI continued to have pain and failed conservative measures despite 90 days of non-weight bearing activity.  An MRI showed OCD of the talus of the right ankle.  In January 2008, the CI continued to have pain resulting in a repeat MRI that showed OCD measuring 12x10x4mm.  On 12 February 2008, the CI underwent an arthroscopy and arthroscopic curettage and drilling of the medial OSD defect lesion of the talus.  

At the 8 April 2008 VA Compensation and Pension (C&P) examination, 13 months before separation, the CI reported pain in the medial aspect of the joint with weight bearing, walking, and stairs.  No locking, effusions, or stiffness was present.  Bracing was used due to non-weight bearing status.  Physical examination showed a normal gait.  Muscle strength was 5/5 and lower extremity deep tendon reflexes were 2+.  No stiffness, weakness, dislocation, subluxation, locking episodes, or effusions were noted.  Range of motion (ROM) showed dorsiflexion 20 degrees (normal 20) with pain beginning at 15 degrees and plantar flexion of 30 degrees (normal 45), with pain beginning at 20 degrees.  Ankle X-rays were negative.  

The 24 April 2008 MEB NARSUM examination, 13 months prior to separation, noted the CI was not limping.  He declined pain medication.  Physical examination noted mild tenderness to the right foot-plantar fascia and over the incision sites.  ROM was “almost” full.  Drawer test (laxity test) and talar lilt (ligament stability) were negative.  Motor strength was 5/5 and sensory was intact to light touch.  At the 31 July 2008 physical therapy appointment for MEB ROMs, 10 months prior to separation, measurements taken with a goniometer showed active dorsiflexion of 5, 5 and 5 degrees (normal 20) and plantar flexion of 44, 42 and 46 degrees (normal 45), with mechanical end range of joint motion recorded as the reason for limitation. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right ankle condition 10%, coded 5284 (foot injuries).  The VA also rated the right ankle condition 10%, coded 5271 (ankle, limited motion), based on the C&P examination, citing moderate limited motion of the ankle.  The panel noted both the NARSUM and C&P examinations were more than a year prior to separation and that the recorded  ROM degraded by the time of the physical therapy examination proximate to the time of separation.  The panel considered the limitation of motion at the time of the physical therapy appointment to be more than moderately limited, and more nearly approximated a “marked” degree of limitation.   The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  However, all panel members agreed that the impairment did not more nearly approximate “severe” to support a 30% rating under this code.   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 right ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Ankle due to OCD Lesion of Talus	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170207, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00721.

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 modification of your assigned disability rating without re-characterization of your 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 direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

2 Attachments:
1.  Directive 
2.  Record of Proceedings