RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01091
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Imagery Analyst, medically separated for “right ankle joint 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 - 20080314	VARD - 20081121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Joint Pain	5099-5003	10%	Right Ankle Tendonopathy	5271	10%	20080930	
Right Wrist Stiffness	Not Unfitting	Right Wrist Strain	5215	0%	20080930	
Esophageal Reflux	Not Unfitting 	Gastroesophageal Reflux Disease	7399-7346	10%	20080930	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Ankle Joint Pain.  According to the service treatment record and MEB narrative summary (NARSUM) the CI underwent right ankle arthroscopy with anterolateral debridement in March 2007.  A post-operative MRI demonstrated a focal area of abnormality of the talar dome suggestive of an early osteochondral lesion, but a subsequent MRI showed a 3-4 millimeter cyst in the talar dome and persistent abnormal thickening of the anterior talofibular ligament and anterior distal tibiofibular syndesmotic ligament suggestive of a remote sprain.   At a physical therapy clinic appointment on 5 February 2008, 3 months prior to separation, the right ankle range of motion (ROM) following repetition showed dorsiflexion of 20 degrees (normal) and pain-limited plantar flexion of 20 degrees (normal 45).  

The 3 March 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of moderate and constant right ankle pain that interfered with the CI’s sleep and caused him to be unable to run.  Physical examination showed the ankle to be non-tender to palpation.  There was no swelling or instability noted, but there was pain with plantar and dorsiflexion movements.  The ROM was grossly normal and did not appear to worsen with repetition.  The examiner noted the CI walked with a pronounced antalgic gait and was unable to toe or heel walk due to right ankle pain.  Tandem walking was also difficult.  

At the 30 September 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported having dull constant pain daily, while increased activity caused increased pain to shoot up the front of the leg.  Physical examination showed no swelling, effusion, tenderness or laxity in the right ankle and the gait was normal.  Right ankle ROM testing, following repetition, showed dorsiflexion of 20 degrees and plantar flexion of 30 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing painful limitation of motion.  The VA also rated the right ankle condition 10%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing tendonopathy with painful and limited 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).  In the absence of ankle ankylosis (5270), subastragalar or tarsal joint ankylosis (5272), os ca calcis or astragalus malformation (5273), or an astragalectomy (5274), a higher rating is not warranted.  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.  

Contended PEB Conditions:  Right Wrist Stiffness and Esophageal Reflux.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions was profiled, implicated in the commander’s statement or noted to fail retention standards.  There was no performance-based evidence from the record that either of the conditions 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 either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right wrist stiffness and esophageal reflux, the panel recommends no change from the PEB determinations as not unfitting.  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.  

	

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Dear XXXXXXXXXXXXXXXXXXXX
:

	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.