RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01199
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20071209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “chronic right ankle pain post sprain” with a disability rating of 10%.  

CI CONTENTION:  “Right ankle is getting worse.”  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 - 20071030	VARD - 20080716	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain Post Sprain	5271	10%	Degenerative Arthritis of the Right Ankle	5271	10%	20080603	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began in April 2007 during a shuttle sprint when she rolled her ankle as she made a turn.  She was referred to the physical therapy (PT) clinic on 28 August 2007 for right ankle instability and a right anterior talofibular ligament (ATFL) tear.  At PT on 4 September 2007, 3 months prior to separation, the CI reported right ankle pain with a severity of 8/10 (10 being the worst pain).  On examination the right ankle range of motion (ROM) goniometric measurements following repetition showed dorsiflexion of 5, 5 and 10 degrees (normal 20) and plantar flexion of 45 degrees (normal 45).  

During the 12 September 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported a right ankle sprain, with associated numbness, tingling, and throbbing.  She used an ankle brace and a TENS (transcutaneous electrical nerve stimulation) unit.  Physical examination showed stiffness and tenderness in the right ankle.  The 2 October 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of severe right ankle pain (8/10) and instability.  Physical examination showed mild anterolateral swelling of the right ankle and tenderness in the right anterolateral ankle gutter.  The CI also had tenderness in the ATFL as well as the posterior calcaneofibular ligament.  She had a mildly positive drawer test (grade I) in the neutral position, and pain with dorsiflexion, inversion, and plantar flexion on passive ROM.  An MRI of the right ankle showed disruption of the ATFL and anterolateral impingement.  Plane film X-rays were within normal limits.  

At the 3 June 2008 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported constant right ankle pain described as aching and sharp with a severity of 9/10, which was elicited by physical activity and was relieved by rest .  She reported weakness, swelling, giving way, and lack of endurance.  Physical examination showed right ankle weakness and tenderness.  Gait was within normal limits.  There were no signs of edema, effusion, redness, heat, or guarding of movement, and there was no subluxation.  X-rays showed mild degenerative arthritis changes related to an old avulsion injury.  ROM of the right ankle showed dorsiflexion of 15 degrees and plantar flexion of 30 degrees.  Pain with motion was noted.  Joint function was additionally limited by pain, fatigue, weakness, and lack of endurance by 0 degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (ankle, limited motion of), citing a moderate loss of motion (12%).  The VA also rated the right ankle condition 10%, coded 5271, based on the C&P examination, citing ROM of the right ankle.  

The panel agreed that the ROM examinations proximate to separation were consistent with the “moderate” limitation of motion required for the 10% rating under this code.  A higher rating of 20% was not indicated in the absence of “marked” limited ROM of the ankle.  There was no  applicable higher rating option in the absence of ankle ankylosis (code 5270), subastragalar or tarsal joint ankylosis (code 5272), malunion of the os calcis or astragalus (code 5273), or having undergone an astragalectomy (code 5274), and there was no tibia and fibula impairment or malunion with moderate knee or ankle disability (code 5262).  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 chronic right ankle pain post sprain condition.  

BOARD FINDINGS:  In the matter of the right ankle pain post sprain 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 20170310, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180007341, 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