RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02114
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, M1 Armor Crewman, medically separated for “chronic right ankle pain”  with a disability rating of 0%.  

CI CONTENTION:  “I have arthritis in my ankle, and constant swelling pain on most days.”  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 - 20060606	VARD - 20061109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	0%	Osteochondritis Dissecans, Right Ankle	5014-5271	10%	20061019	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a right ankle arthroscopy in June 2004 with debridement of a lesion and irrigation of ankle debris.  Ankle X-rays and an MRI revealed mild surface wear on the bearing tibial talar surfaces and a significant bone contusion interpreted as a microfracture involving the anterior tibia and body of the talus, and reflecting multiple inversion incidents.  

The 2 May 2006 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of ankle instability with “rolling over” once a week and considerable pain and swelling.  Physical examination revealed tenderness and slight swelling.  Right ankle range of motion (ROM) following repetition showed dorsiflexion of 30 degrees (normal 20) and plantar flexion of 60 degrees (normal 45) per goniometer.  Painful motion was not noted.  During the 12 May 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported of constant swelling, and the examiner documented right ankle pain with weight bearing.  

At the 19 October 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported chronic right ankle pain almost every day.  Physical examination revealed a normal gait and no deformities, tenderness or swelling.  Right ankle ROM following repetition showed dorsiflexion of 10 degrees and plantar flexion of 35 degrees, with pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing “analogous to degenerative arthritis without significant loss of joint motion.” The VA rated the right ankle condition 10%, coded 5014-5271 (osteomalacia-ankle, limited motion of), based on the C&P examination, citing “plantar flexion and dorsiflexion are moderately limited (to 35 degrees and 10 degrees respectively).”  Members assigned more probative value to the C&P examination, as the reporting was more complete, fully VASRD compliant and better reflected the overall disability picture.  There was limitation of dorsiflexion and plantar flexion with pain per the C&P examination that supported a rating under code 5271.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt) and VASRD §4.7 (higher of two evaluations), the panel recommends a disability rating of 10% for the right ankle condition, coded 5014-5271.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 10%, coded 5014-5271 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	
Chronic Right Ankle Pain	5014-5271	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180016695, 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 tor 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