RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00733
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20051020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Food Service Operations, medically separated for “chronic right ankle pain” with a disability rating of 0%.   

CI CONTENTION:  “Review all conditions.”  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 - 20050829	VARD - 20060310	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	0%	Right Foot 5th Metatarsal Base Fracture 	5284-5271	10%	20051202	
Hypothyroidism	Not Unfitting	Grave’s Disease 	7900	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right ankle condition began in July 2004 after recovering from right foot surgery on the fifth metatarsal in January 2004.  At the 15 July 2004 Physical Therapy (PT) clinic appointment, 15 months prior to separation, the CI reported soreness deep in medial right ankle with 4/10 pain.  Pain was aggravated by prolonged standing greater than 10 minutes and walking.  Physical examination showed an antalgic gait with no edema, discoloration, atrophy or instability.  Range of motion (ROM) was recorded as full with complaints of pain.  
At the 10 June 2005 orthopedic examination, 4 months prior to separation, showed ROM measurements with dorsiflexion of 15 degrees (normal 20) and plantar flexion of 40 degrees (normal 45).  There was normal motor strength and no signs of instability.  An MRI was negative and there was no surgical intervention.  The 8 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, showed normal lower extremities and full ROM of the feet.  The examiner recorded that an MRI on 18 May 2005 showed a normal right ankle.  During the 16 August 2005 MEB NARSUM, 2 months prior to separation, the CI complained of right ankle pain, which limited his ability to perform impact activities or MOS duties.  Physical examination noted dorsiflexion of 15 degrees and plantar flexion of 40 degrees.  Strength was normal and the ankle was stable with no evidence of talar tilt or excessive drawer.  

At the 2 December 2005 VA Compensation and Pension (C&P) examination, 1 month after separation, noted symptoms of pain, limitation of motion and inability to pivot foot.  Physical examination showed a normal gait and ankle joint appearance.  ROM testing showed dorsiflexion of 10 degrees and plantar flexion of 45 degrees.  There was no additional limitation after repetitive motion.  X-rays showed a small area of bony compression to the anterior tibia suggestive of an axial force injury.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, analogously coded 5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy with slight and intermittent pain.  The VA rated the right ankle condition 10%, dual coded 5284-5271 (foot injuries, other-ankle, limited motion of; moderate), citing limitation of motion.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However there was evidence of painful motion causing functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 chronic right ankle condition, coded 5099-5003.  

Contended PEB Condition:  Hypothyroidism.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The commander’s statement implicated the condition by citing temporary profile limitations, but the condition was not permanently profiled or judged to fail retention standards.  Although there are some indications in the STR that the CI was having difficulty maintaining “normal” thyroid functioning, and suffered from fatigue and intolerance of temperature extremes, the preponderance of evidence did not indicate that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended hypothyroidism, the panel unanimously recommends no change from the PEB determination as not unfitting.  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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Ankle Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170220, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180004795, 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