RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01140
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061023

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

CI CONTENTION:  His condition continues to negatively impact daily 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 PEB - 20060828	VARD - 20061207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain and Talotibial Joint Instability	5099-5003	0%	Chronic Right Ankle with Anterior Tibial Spur and Talotibial Joint Instability	5271-5262	10%	20061017	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began in February 2003 after running during basic training.  He continued to experience pain with running while deployed.  A right ankle CT scan on 13 January 2006, 9 months prior to separation, was “essentially unremarkable.”

The 30 March 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of chronic right ankle pain and instability.  Physical examination showed the lower extremities were neurovascularly intact with motor strength of 4+/5 in the peroneal muscles (move upper and lower ankle joints) and 5/5 elsewhere.  Deep tendon reflexes were 2+ (normal).  The CI had right ankle and foot tenderness.  Right ankle range of motion (ROM) was dorsiflexion to 15 degrees (normal 20) and plantar flexion to 35 degrees (normal 45); painful motion was present.  During the physical therapy examination on 18 July 2006, 3 months prior to separation, the CI reported chronic right ankle pain aggravated by sitting and walking.  Pain was mitigated by an ankle brace and rest.  Physical examination revealed a normal gait.  There was right ankle tenderness.  Repetitive-goniometric measured right ankle dorsiflexion was 10 degrees and plantar flexion was 35 degrees; painful motion was noted.  

At the 17 October 2006 VA Compensation and Pension (C&P) general examination, 1 week before separation, the CI reported right ankle pain associated with running and marching.  He wore an ankle brace when he went on walks.  Physical examination showed a normal gait.  There was no swelling, no discoloration, and no crepitus.  Right ankle color and texture were normal.  There was right ankle tenderness.  Motor testing of all foot and ankle groups was 5/5.  Sensory was intact to light touch in all areas of the lower extremities.  Right ankle dorsiflexion was 15 degrees and plantar flexion was 65 degrees.  Repetitive motion caused pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the right ankle condition 10%, coded 5271-5262 (ankle, limited motion - tibia and fibula, impairment) based on the C&P examination, citing additional limitation of the joint due to pain.  

The panel agreed 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 sufficient STR and VA evidence of painful motion to support a 10% rating IAW VASRD §4.59.  There was no VASRD §4.71a ankylosis, nonunion, or malunion criteria to support a higher rating.  The panel also considered rating under code 5284 (other foot injuries).  A 30% rating requires “severe” impairment; 20% requires “moderately severe”.  The panel deliberated and determined that the CI’s right ankle ROM, motor strength, reflexes, sensitivity, and overall functionality did not approximate a “moderately severe” impairment to support a 20% rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right ankle condition, coded 5299-5271.

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 10%, coded 5299-5271 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	
Right Ankle Pain and Talotibial Joint Instability	5299-5271	10%	

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.