RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00754
BRANCH OF SERVICE:  ArMY 	SEPARATION DATE:  20080207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “left ankle pain” with a disability rating of 10%.  

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 - 20090317	VARD - 20080604	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5271	10%	Residuals Gunshot Wound, Left Ankle	5311	20%	20080326	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Left Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in May 2006 after he sustained a gunshot wound to the left distal tibia while deployed to Afghanistan.  He underwent incision, drainage and external fixation surgery, but had an additional surgery to place screws in his ankle, which were removed on 15 June 2007.  At the 21 August 2007 physical therapy (PT) clinic appointment, 6 months prior to separation, the CI reported increased pain with activity.  Physical examination showed no edema and normal strength of the left ankle.  Range of motion (ROM) measurements showed dorsiflexion to 5 degrees (normal 20) and a normal plantar flexion of 45 degrees.  At a follow up PT appointment for PEB ROM measurements on 11 October 2007, the CI showed dorsiflexion of 0 degrees and plantar flexion of 38 degrees, compared to the right ankle that showed dorsiflexion of 10 degrees and plantar flexion of 55 degrees.   

At the 20 November 2007 orthopedic appointment, 3 months prior to separation, the CI reported pain with swelling and slight tenderness to palpation.  The pain was worse with climbing stairs, prolonged walking and weight bearing.  Physical examination showed a normal gait and the CI was noted to walk on heels and toes without difficulty.  ROM measurements showed dorsiflexion of 10 degrees and plantar flexion of 20 degrees.  There was normal strength and reflexes, and no muscle atrophy, sensory abnormality, joint effusion, inflammation or instability.  

At the 28 March 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported throbbing pain in his ankle with overuse, such as prolonged standing.  Physical examination showed decreased reflexes, but he had a normal gait, normal strength and no evidence of deformity, giving way or instability.  ROM measurements showed dorsiflexion of 10 degrees and a normal plantar flexion of 45 degrees.  There was an additional loss of 5 to 10 degrees loss of dorsiflexion with repetitive use.  Radiographic studies showed abnormal texture of the bone at the distal tibia adjacent to the ankle joint, but no joint abnormalities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5271 (limited motion of the ankle), citing moderate loss of motion.   The VA rated the left ankle condition 20%, coded 5311 (Group XI Function), citing a moderately severe muscle disability, with evidence of entrance and exit scars indicating track of missile through one or more muscle groups with loss of deep fascia muscle substance or normal firm resistance of muscles and evidence of impairment with tests of strength and endurance compared with sound side. 

The panel considered if the limitation of motion was “moderate” or “marked” when considered under 5271, limitation of ankle motion.  The orthopedic examination recorded loss of dorsiflexion with a normal gait, near normal plantar flexion, and no evidence of muscle dysfunction.  Members agreed that the preponderance of evidence was more reasonably characterized as “moderate” limitation of motion, which was consistent with a 10% rating under diagnostic code 5271.  A higher rating of 20% was not indicated in the absence of consistent “marked” limited ROM of the ankle.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  The panel also considered the muscle code as adjudicated by the VA.  Although there was evidence of a previous muscle injury, the examinations proximate to separation did not support muscle dysfunction significant enough to rise to a level that would constitute a rating advantage to the CI.  Finally, there was no ankylosis, nonunion or malunion of the long bones of the leg therefore, VASRD §4.71a offers no applicable code which would yield a rating higher than the 10% rating adjudicated by the PEB.  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 left ankle condition.   

BOARD FINDINGS:  In the matter of the left 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 20170215, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004810, 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