RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01916
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071115

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

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 – 20071001	VARD - 20080702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5099-5003	0%	Left Ankle Strain	5271	10%	20080507	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in January 2007 when he rolled his ankle while marching.  Radiographic studies revealed no evidence of fracture or dislocation, the ankle mortise appeared intact, and there was no evidence of arthritic or inflammatory change.  At the time of the physical therapy clinic appointment on 13 August 2007, 3 months prior to separation, the CI reported 8/10 left ankle pain.  Left ankle range of motion (ROM) showed 15 degrees of dorsiflexion (normal 20) and 40 degrees of plantar flexion (normal 45).  The 5 September 2007 MEB NARSUM, 2 months prior to separation, noted complaints of left ankle pain.  The physical examination (PE) noted the ROM was unchanged from the physical therapy appointment a month earlier.  Tenderness, swelling and painful motion was present.    

At the 7 May 2008 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported left ankle symptoms of weakness, stiffness, swelling and giving way.  He reported constant 8/10 pain.  His PE revealed a normal gait and the ankle showed no signs of edema, effusion, weakness, tenderness, redness, heat, subluxation or guarding of movement.  Left ankle ROM was full, but there was evidence of painful motion.  X-ray studies were normal.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition at 0%, analogously coded 5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy, rated as constant and minimal.  The VA rated the left ankle condition at 10%, coded 5271 (limited motion of the ankle), citing painful motion of a major joint and moderate limited motion of the ankle.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However there was evidence of painful motion causing functional loss supporting the 10% rating (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. All members agreed there was evidence to support a 10% rating based on functional loss due to painful motion (§4.59).  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 left ankle condition, analogously coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Ankle Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170220, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005907, 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