RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02374
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Military Police, medically separated from the Temporary Disability Retired List (TDRL) for “status post right ankle fracture” and “chronic back pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “Lumbar condition, right ankle, depression.”  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 - 20050628	VARD - 20060303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Right Ankle Fracture	5271	10%	Residuals of Right Ankle Fracture	5271	10%	20060107	
Chronic Back Pain	5243	10%	Residuals, L4-5 Microdiscectomy, DJD L4-5 and L5-S1	5295-5242	10%	20060107	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Status Post Right Ankle Fracture.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI broke his right ankle in October 2000, when a cable cross over machine fell on his right leg.  He was separated and placed on TDRL on 8 January 2002.   

The 8 March 2005 TDRL evaluation, 4 months prior to TDRL removal, noted CI complaints of some discomfort, but no significant pain.  On examination, the right ankle range of motion (ROM) showed dorsiflexion of 5 degrees (normal 20) and plantar flexion of 20 degrees (normal 45).  Testing for ligamentous instability was negative.  

At the 7 January 2006 VA Compensation and Pension (C&P) examination, 6 months after TDRL removal, physical examination revealed a gait was normal.  Right ankle ROM, following repetition, showed dorsiflexion of 20 degrees and plantar flexion of 45 degrees with motion not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271, (limited motion of the ankle), citing moderate limitation of motion.  The VA also rated the right ankle condition 10%, coded 5271, based on the C&P examination, citing moderate limited motion of the ankle.  Members agreed the limitation of motion was no more than “moderate,” therefore supporting the 10% rating adjudicated by the PEB.  A higher rating of 20% was not indicated in the absence of “marked” limited ROM of the ankle.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable or not advantageous to rating.  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.  

Chronic Back Pain.  According to the STR and MEB NARSUM, the CI complained of back pain with right radicular pain in 2000.  Upon evaluation he was found to have a herniated disc, and on 13 October 2000, he underwent right L4-L5 microdiscectomy with relief of his sciatica.  

The March 2005 TDRL evaluation noted CI complaints of pain radiating down to the right thigh at a severity of 5/10.  There was mild tenderness, and thoracolumbar ROM measurements showed flexion of 80 degrees (normal 90), extension of 20 degrees (normal 30), right lateral flexion of 15 degrees (normal 30), left lateral flexion of 15 degrees (normal 30).  NOTE:  Missing rotation measurements equated to a combined ROM of greater than 125 degrees but less than 195 degrees (normal 240).  

At the 7 January 2006 C&P spine examination, 6 months after TDRL removal, the CI reported low back pain that was greater on the right than left, and exacerbated by cold or rainy weather, any activities, and turning a certain way.  Approximately every month, he was bedridden for about 3 days, with the longest exacerbation lasting 4-5 days.  Physical examination showed a normal gait, and thoracolumbar flexion to 45 degrees with a combined of ROM 195 degrees after repetition.  There was no additional limitation with repetitive motion. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing moderate limitation of motion.  The VA also rated the back condition 10%, dual coded 5295-5242 (degenerative arthritis of the spine), based on the C&P examination, citing thoracolumbar forward flexion greater than 60 degrees but not greater than 85 degrees; or, combined ROM greater than 120 degrees but not greater than 235 degrees.  Members agreed that a 10% rating, but no higher, was justified for limitation of flexion, as reported on the TDRL examination, which was most proximate to TDRL removal and thus had the highest probative value for rating.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 back condition.  
BOARD FINDINGS:  In the matter of the status post right ankle fracture condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the chronic back pain 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 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010796, 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