RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02269
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Operating Room Specialist, medically separated for “chronic pain of the right ankle and foot secondary to right calcaneonavicular coalition” with a disability rating of 20%.  

CI CONTENTION:  Review of all conditions requested. 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 - 20071011	VARD - 20080514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Ankle and Foot	5099-5003	20%	S/P Right Ankle Surgery	5019-5271	0%	20080324	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Pain of the Right Ankle and Foot.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a right calcaneonavicular coalition (abnormal connecting bridge of tissue between two bones) excision as well as lengthening of the same Achilles tendon on 31 August 2006.  The 30 July 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of chronic right ankle/foot pain.  Physical examination (PE) revealed tenderness, painful motion about the right ankle/foot and an antalgic limp.  There was no joint instability.  Physical therapy performed MEB measurements on 7 August 2007.  Right ankle range of motion (ROM) following repetition showed dorsiflexion of 12 degrees (normal 20) and plantar flexion of 25 degrees (normal 45) with pain.  

At the 24 March 2008 VA Compensation and Pension (C&P) examination, one month after separation the CI reported constant right ankle pain.  The PE revealed a normal gait and no evidence of local tenderness, swelling, effusion, crepitus, limitation of motion, or ligamentous instability about the right ankle.  ROM following repetition was normal and without pain.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition 20%, analogously coded 5099-5003 (degenerative arthritis), citing application of the US Army Physical Disability Agency Pain policy.  The VA rated the ankle condition 0%, coded 5019-5271 (bursitis-ankle, limited motion) based on the C&P examination, citing no objective evidence showing pain resulting in loss of ROM or moderate limited motion of the ankle.

Although the PT MEB ROM examination supports a minimum 10% rating for moderate limitation of motion under VASRD code 5271 or a 10% rating based on painful motion (VASRD §4.59), the VA examination one month after separation revealed no evidence of painful or limited motion supporting a 0% rating.  VASRD code 5284 (foot injuries; other) was not supported for the same reason of normal physical findings within one month of separation.   IAW DoDI 6040.44, the panel may not recommend a rating lower than that received prior to application.  Therefore, 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’s adjudication for the chronic right ankle/foot pain.  

BOARD FINDINGS:  In the matter of the right ankle/foot 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs

AR20190007787, 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