RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01324
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20081016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic right ankle pain due to residual of Achilles tendon rupture and reconstructive surgery” 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 - 20080925	VARD - 20090601	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain…	5399-5311	10%	Residuals, Right Ankle Achilles Tendon Rupture, S/P Surgical Repair	5284-5271	20%	20081230	
			Scar, Right Ankle Achilles, Tendon Repair	7804	10%	20081219	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI ruptured her right Achilles tendon on 10 March 2008 and underwent surgical repair on 24 March 2008.  Her ankle pain persisted despite rehabilitative physical therapy.  The 21 August 2008 MEB NARSUM, 2 months prior to separation, noted that the CI was unable to run, march or stand for prolonged periods of time.  She described painful flare-ups with simple activities such as going up and down stairs; although, she could walk on a treadmill for up to 8 minutes without having to stop due to pain.  The physical examination (PE) noted a normal gait and stance with a well-healed surgical scar over the right Achilles tendon and tenderness about the right heel.  Tests for ankle instability, strength and range of motion (ROM) were normal with pain present only at motion endpoints.  There was no weakness, incoordination or lack of endurance noted.   

At the 30 December 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI complained of continued right ankle/Achilles tendon throbbing with pain rated at 5/10 and lasting all day.  She reported prolonged walking as well as rain and cold weather exacerbated her pain, but denied any flare-ups.  The PE revealed tenderness along the Achilles tendon and significant right calf muscle atrophy with 3 centimeters less in circumference compared to the left.  Hind foot alignment remained neutral on weight bearing and there was no crepitus.   Right ankle ROM was 15 degrees of dorsiflexion (normal 20) and 30 degrees of plantar flexion (normal 45) with pain, fatigue, weakness and lack of endurance during repetitive motion.  X-rays revealed minimal osteoarthritic subtalar and intertarsal ankle joint changes.  The provider’s assessment noted:

“Right Achilles tendon rupture, status post-surgical repair with transfer of the plantaris tendon with residuals of pain, weakness, lack of endurance, as well as incoordination.  She is still early in the postoperative period relatively speaking.  These injuries continue to improve anywhere up to a year from the time of their repair, and she has been delayed in her rehab in that she has been unable to attend PT.  After she was discharged, she was not plugged into the appropriate care in the VA system.  I recommend she be reevaluated in 1 year after she has obtained maximal medical improvement.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5399-5311 (Group XI Function: propulsion, plantar flexion of foot…), citing “VASRD 4.20 and the U.S. Army Physical Disability Agency Memorandum 12, Table of Analogous Codes, rated as moderate IAW cardinal signs of lowered threshold of fatigue when compared to the sound side.”  The VA rated the right ankle condition 20%, coded 5284-5271 (foot injuries, other/limited motion of the ankle), citing marked limited motion of the ankle.  Members considered physical findings from both the NARSUM and VA examinations, and in the absence of marked joint deformity or any degree of ankylosis, deliberated over an impairment rating under VASRD code 5271 (ankle; limited motion).  Additional consideration was given to code 5311 (muscle group XI) secondary to the presence of local atrophy as well as the original etiology from muscle and soft tissue injury rather than the bones. The panel majority agreed that with either code, the maximum supportable rating was 10% “moderate” under 5271 or “moderate” under 5311.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the right ankle pain condition. 

BOARD FINDINGS:  In the matter of the chronic right ankle pain condition and IAW VASRD §4.73, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 20% and elected not to submit a minority opinion.  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 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004943, 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