RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01907
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “multiple right ankle strains” with a disability rating of 0%.  

CI CONTENTION:  “Further deterioration of right shoulder with worsening arthritis, further deterioration in lumber back with worsening arthritis.”  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 - 20070126	VARD - 20070918	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multiple Right Ankle Strains	5099-5003	0%	Right Ankle Strain	5271-5010	10%	20070703	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Multiple Right Ankle Strains.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began in April 2005 after he sustained a sprain during a ruck march.  X-rays showed soft tissue swelling and effusion.  An MRI showed osteochondral defect of the lateral talar dome and peroneus brevis split tear.  Subsequent X-ray studies from 8 June 2006 showed marked ligamentous laxity of the right ankle with possible old chip fractures.  

At the time of the orthopedic clinic appointment on 21 September 2006, 6 months prior to separation, the CI reported right ankle giving way with activities of daily living and that the instability was worse than the pain.  Physical examination showed positive mild anterior drawer but with marked talar tilt clinically and distally neurovascular intact.  There was no evidence of abnormal gait reported.  The examiner opined that “ankle surgery is an established procedure that qualified orthopedists would recommend,” and “the Soldier’s refusal to undergo surgery is reasonable.”  

During the 17 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported wear of an ankle brace and that he had been advised to have a surgery.  Physical examination showed full range of motion (ROM), no edema and normal gait.  However, there was mild tenderness over the lateral aspect, minimal anterior drawer and mild lateral laxity.  The 7 December 2006 MEB NARSUM, 3 months prior to separation, noted right ankle pain and instability.  The examiner referred to the physical examinations by the orthopedic clinic in September 2006 and the MEB examination on 17 November 2006.  

At the 3 July 2007 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported right ankle pain.  Physical examination showed a normal gait and full ROM of the right ankle with pain at the extreme of dorsiflexion.  There was normal reflexes and normal strength.  X-ray studies showed minimal degenerative arthritic changes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, analogously coded 5003 (arthritis, degenerative), citing no significant loss of motion.  The VA rated the right ankle condition 10%, coded 5271-5010 (ankle, limited motion-arthritis, due to trauma), citing painful motion.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  The panel noted the history of recurrent ankle strains with reports of pain and instability.  The panel noted the multiple providers documented treatment note objective findings of mild right ankle instability and pain.  Panel member agreed that the evidence supports a 10% rating for instability and pain with use causing functional loss (based on §4.59, §4.40 and §4.45).  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right ankle condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Multiple Right Ankle Strains	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170313, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005903, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,					      
Enclosure