RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01505
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “limited motion of right ankle following arthroscopic surgery” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20090312	VARD - 20090728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Limited Motion of Right Ankle	5271	10%	Status Post Right Ankle Surgery with Residual Osteoarthritis Status Post Right Ankle Fracture	5271	0%	20081009	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Limited Motion of Right Ankle.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had multiple ankle sprains with a distal tibia avulsion fracture that did not heal (nonunion).  He underwent right ankle arthroscopic surgery in April 2008 for right ankle anterior impingement and malleolus delayed union (reattachment of the deltoid ligament, synovectomy, and osteophyte excision).  

At the 9 October 2008 VA Compensation and Pension (C&P) examination, 8 months before separation, the CI reported right ankle pain and swelling with flares with activity.  Physical examination showed normal gait and heel/toe walking.  The right ankle was tender with mild ecchymosis and a well-healed surgical scar.  There was normal range of motion (ROM) with dorsiflexion of 20 degrees and plantar flexion of 45 degrees.  No limitations in ROM from pain, fatigue, weakness, or lack of endurance with repetitive use were noted.  

Physical therapy ROMs from 23 October 2008, 7 months prior to separation, showed dorsiflexion of 10 degrees and plantar flexion of 50 degrees with painful motion.  The 20 February 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic right ankle pain status-post surgery for delayed union of fracture of the right medial malleolus.  MRI on 29 December 2008 showed chronic ligament tears and tenosynovitis.  Physical examination showed a slight limp favoring the right leg.  There was painful right ankle dorsiflexion and inversion with slight decrease in ROM and tenderness observed on ambulation.  The physician referenced the PT ROMs.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (limited motion of ankle), citing moderate limitation of motion.  The VA rated the right ankle condition 0%, also coded 5271, based on the C&P examination, citing lack of pain or limitation of motion.  All panel members agreed there was adequate evidence of painful motion IAW VASRD §4.59 and that the limitation of motion was no more than “moderate,” therefore supporting the 10% rating adjudicated by the PEB.  A higher rating of 20% was not indicated in the absence of “marked” limited ROM of the ankle.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable or not advantageous to rating.  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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180008977, 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