RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01736
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cannon Crewmember, medically separated for “chronic right ankle pain” with a disability rating of 20%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20061226	VARD – 20070316	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5271	20%	Status Post Traumatic Injury to Right Ankle with Surgical Repair and Restriction in ROM	5271	10%	20060809	
COMBINED RATING:  20%	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 sustained a dislocation of the right ankle with fracture of the tibia and fibula and underwent open reduction with internal fixation on 10 January 2006.  On 26 April 2006, the CI underwent removal of the syndesmosis screw.  The 9 August 2006 X-ray showed repair of an old healed fracture of the distal right fibula and otherwise normal ankle.  The 28 April 2006, orthopedic examination, 9 months prior to separation, noted that the CI had no complaints of pain.  Physical examination showed decreased right ankle active motion.  There was no swelling, deformity, tenderness, painful motion, instability, or weakness.  No range of motion (ROM) measurements were reported.  
The 24 October 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued pain despite surgery and rehabilitation.  Physical examination showed edema (swelling).  There was no tenderness or erythema (redness).  The examiner referred to the ROM measurements done by physical therapy on 2 November 2006 which showed right ankle ROM of dorsiflexion to 3 degrees (normal 20) and plantar flexion to 18 degrees (normal 45).  The therapist stated the motion was restricted due to mechanical (degenerative) limitations.  

At the 9 August 2006 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported weakness, stiffness, lack of endurance, and fatigability, and pain that occurred intermittently.  Pain was rated at 4-5/10.  Physical examination showed no edema, effusion, weakness, tenderness, redness, heat, or abnormal movement.  Posture and gait were normal.  ROM was dorsiflexion of 10 degrees and plantar flexion of 35 degrees.  Pain, weakness, lack of endurance, fatigue, or incoordination did not impact further on ROM after repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, coded 5271 (limited motion of the ankle), citing marked decrease in range of motion.  The VA rated the right ankle condition 10%, coded 5271, based on the C&P examination, citing moderate limitation of motion.  The panel noted that the PEB assigned the maximum rating (20%) available under the diagnostic code 5271.  The panel noted the underlying cause for the ankle impairment was residuals of a fracture of the tibia and fibula and considered a rating using the VASRD diagnostic code 5262 (impairment of the tibia, fibula, and ankle).  However, there was no nonunion or malunion present to support that approach.  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 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 20170226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005841, 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