RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01688
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “chronic right ankle pain” with a disability rating of 10%.  

CI CONTENTION:  No specific contention 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 - 20051117	VARD - 20060630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	Residuals, Right Ankle with Instability	5271	10%	20060522	
			Sural Neuritis, Right Lower Extremity	8599-8520	10%	20060522	
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’s right ankle condition began in November 2002 after playing football in Korea.  On 28 January 2005 the CI underwent right ankle lateral ligament reconstruction.  After surgery the CI reported persistent sensation of right ankle instability, decreased motion, and pain radiating in the right foot.  The 24 August 2005 nerve studies demonstrated findings consistent with right sural nerve neuropathy.  

The 26 September 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of 4/10 right ankle pain which increased with impact activities.  Physical examination showed a well-healed incision on the lateral right ankle, decreased sensation alone the entire course of the sural nerve, and a positive Tinel’s (nerve entrapment sign) over the distal portion of the incision with radicular pain along the sural nerve.  The range of motion (ROM) was 30 degrees of plantar flexion (normal 45) and 5 degrees of dorsiflexion (normal 20).  

At the 13 April 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported ongoing 1-2/10 ache in his right ankle which increased to a 5/10 with re-sprains.    Physical examination showed a normal gait and a well-healed right lateral malleolus scar.  ROM was dorsiflexion to 15 degrees and planter flexion to 40 degrees with discomfort at end of both planes of motion.  There was no further limitation of motion or pain with repetitive motion.  

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 (degenerative arthritis), citing pain with some loss of motion. The VA rated the right ankle condition 10%, coded 5271 (ankle limitation of motion), based on the C&P examination, citing moderate limitation of ankle motion and instability.  The VA also rated the right ankle condition 10%, analogously coded 8599-8520 (sciatic nerve, incomplete paralysis mild), citing right ankle numbness and paresthesia.  The panel considered if the limitation of motion was “moderate” or “marked” when considered under 5271, limitation of ankle motion.  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.  The panel also considered additional rating of the right ankle condition for the sural nerve injury; however, the evidence did not support that the sensory dysfunction was unfitting.  There was no gait abnormality or motor dysfunction that rose to the level of unfitting.   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 chronic right ankle pain and instability 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 20170308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008637, 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