RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00850
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E3, Automated Logistics Specialist, medically separated for “ankle, limited motion of” with a disability rating of 20%.  

CI CONTENTION:  “Continued complications due to condition; secondary injury has occurred, arthritis and bursitis in right hip.”  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 - 20091005	VARD - 20100507	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ankle, Limited Motion	5271	20%	Residuals, Right Ankle Fracture…	5271	10%	20100218	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Limited [Right] Ankle Motion.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered a right ankle fracture (bimalleolar) during basic training that required an open reduction with internal fixation in June 2009.  Post-operative X-rays showed intact hardware with good alignment, but the condition could not be rehabilitated to permit a timely resumption of training.  There was no evidence in post-operative STR entries that was probative to VASRD rating.

The 10 September 2009 MEB NARSUM examination, 3 months after surgery and 1 month prior to separation, documented daily ankle pain that flared with prolonged walking.  The physical examination recorded an antalgic gait (still partial weight-bearing with crutches and boot), tenderness with no wound complications, no instability and normal strength.  The NARSUM referenced range of motion (ROM) measurements by physical therapy (PT) from two weeks earlier (24 August), with dorsiflexion limited to minus 5 degrees (normal 20) and plantar flexion to 12 degrees (normal 45), specifying painful motion.

At the 18 February 2010 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported continued right ankle pain, rated at 3/10, that limited prolonged standing or walking.  The physical examination recorded a normal gait, non-painful surgical scars, lateral joint tenderness, and normal alignment and strength.  Dorsiflexion was to 20 degrees and plantar flexion to 40 degrees, with end range pain but no ROM loss with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, coded 5271 (limitation of motion), citing the PT ROM measurements and referencing the VASRD.  This is the maximum rating under code 5271 for “marked” limitation.  The VA rated the condition 10%, coded 5271, based on the C&P examination and citing the applicable “moderate” criterion.  There was no ankylosis, nonunion or malunion, or other ratable criterion in evidence that would support a rating higher than 20% under any applicable joint code available in VASRD §4.71a.  The panel considered a higher 30% rating for functional impairment under code 5284 (foot injuries, other) for “severe” disability or under code 5299-5262 (analogous to tibia and fibula, impairment of) for “marked” contiguous ankle disability.  Although there was significant gait disturbance and functional limitations still present at separation, the CI had not fully recovered from surgery and the panel agreed that this was not a reasonable baseline for permanent rating.  The latter was best captured by the functional evidence from the C&P examination, which members agreed was not reasonably aligned with the above criteria for a higher rating under either of the alternate codes.  After due deliberation, considering all 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.  

AR20190007513, 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.