RECORD OF PROCeediNGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02460
BRANCH OF SERVICE:  army	SEPARATION DATE:  20080207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transportation Operator, medically separated for “right ankle limitation of motion” and “left ankle limitation of motion,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  In addition to review of the left and right ankle conditions, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20090318	VARD - 20080305	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Limitation of Motion	5271	10%	Left Ankle Status Post Traumatic Injury	5271	10%	20071204	
Left Ankle Limitation of Motion	5271	10%	Right Ankle Pain and Instability	5271	NSC		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Ankle Limitation of Motion.  According to the MEB NARSUM and service treatment record (STR), the CI underwent right ankle surgery in April 1999 prior to service.  The CI reported injuring his right ankle in 2003 after jumping off a wall during basic training, but he did not seek medical treatment at that time.  Right ankle pain was subsequently reported without further surgical indication.  A primary care examination on 19 September 2007 noted a normal gait and stance and “normal movement of all extremities.”  During the 27 September 2007 MEB NARSUM examination, 4 months before separation, the CI reported on and off right ankle pain with certain movements.  Physical examination showed minimal right ankle tenderness, but no swelling.  Bilateral ankle strength was normal.  The 28 September 2007 MEB PT ROM examination revealed, after repetitive measurements, right ankle dorsiflexion to 5 degrees (normal 20) and plantar flexion to 32 degrees (normal 45).  Painful motion and joint tenderness were present.  A primary care examination on 1 November 2007 showed ankle abnormalities and “abnormal motion.”  

During the 4 December 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI complained of aching and sharp right ankle pain that was elicited with physical activity.  There was also daily intermittent weakness, stiffness, swelling, redness and give-way Physical examination revealed a normal gait.  The CI did not use or wear any assistive device.  Right dorsiflexion was 20 degrees and plantar flexion was 45 degrees.  There was no loss of ankle ROM with pain, weakness, lack of endurance, fatigue or incoordination following repetitive use.  
The CI underwent a right Brostrom-type revision and partial tendon transfer on 27 February 2008, less than 1 month after separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (ankle, limited motion), citing dorsiflexion of 0 degrees.  The VA did not service connect the right ankle condition, citing no permanent residual or chronic disability subject to service connection.  

The panel considered if the CI’s right ankle limitation of motion was “moderate” or “marked” when considered under code 5271.  The panel considered the somewhat disparate examinations and agreed the evidence from the MEB PT ROM examination (dorsiflexion of 5 degrees), primary care examination (abnormal right ankle motion) and right ankle surgery less than 1 month after separation, supported a rating of 10% for moderate ankle disability.  Altogether the aforementioned hold a higher probative value than the VA ROM examination (right ankle dorsiflexion 20 degrees), which was markedly improved from all prior examinations, but laxity was not addressed.  Additionally, the CI had a normal gait on NARSUM examination, which favors moderate limitation of the ankle rather than marked limitation of motion.  Thus, the right ankle condition approximates a “moderate” limitation of motion to support a 10% rating at the time of separation.  The panel considered alternative VASRD ankle and analogous codes (5262, 5270, 5272, 5273), but all were not applicable to the CI’s right ankle condition.  After due deliberation, 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 adjudication for the right ankle condition.  

Left Ankle Limitation of Motion.  According to the MEB NARSUM and STR, the CI underwent a left ankle Brostrom repair for instability in November 2006 and deployed shortly thereafter.  A PT examination on 7 February 2007 showed a mild antalgic gait.  Left ankle dorsiflexion strength was “fair” and plantar flexion was “good.”  Left ankle dorsiflexion lacked 3 degrees (17 degrees) with pinching pain, and plantar flexion was 39 degrees.  The CI reported instability and pain in the anterior ankle joint on 2 April 2007.    He subsequently underwent soft tissue arthroscopic surgery on the left ankle on 9 May 2007, but continued to be symptomatic after a history of twisting the ankle.  A primary care examination on 19 September 2007 noted the CI had a normal gait and stance and “normal movement of all extremities.” 

During the MEB NARSUM examination the CI reported constant left ankle pain that worsened with running, walking, swimming or biking.  Physical examination showed left ankle tenderness around the lateral malleolus and minimal swelling.  Ankle strength was normal.  The MEB PT ROM examination revealed, after repetitive measurements, left dorsiflexion of 0 degrees and plantar flexion of 30 degrees.  Painful motion and joint tenderness were present.  A primary care examination on 1 November 2007 indicated ankle abnormalities and “abnormal motion.”  The left ankle showed swelling, and pain was elicited by motion. 

During the C&P examination, the CI complained of daily left ankle aching, cramping and sharp pain with weakness, stiffness, swelling, redness and give-way.  Physical examination revealed a normal gait.  The CI did not use or wear any assistive device.  Left dorsiflexion was 10 degrees and plantar flexion was 30 degrees.  There was no loss of ankle ROM with pain, weakness, lack of endurance, fatigue or incoordination following repetitive use.  The CI underwent a left ankle Brostrom-type lateral ligament reconstruction revision, partial tendon transfer and limited debridement on 2 June 2008, 4 months after separation, for left ankle chronic sprain, lateral ligament instability, and post traumatic arthrosis. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5271, citing dorsiflexion of 0 degrees.  The VA also rated the left ankle condition 10%, coded 5271, based on the C&P examination, citing moderate limited motion. 

The panel considered if the CI’s left ankle limitation of motion was “moderate” or “marked” when considered under 5271.  The panel agreed that the totality of the MEB PT ROM examination (left dorsiflexion 0 degrees) and primary care examination (abnormal left ankle motion), support a 10% rating.  Additionally, the left ankle surgery, 4 months after separation, for a history of painful motion and ligamentous laxity could also support a 10% rating for functional loss and painful motion IAW VASRD §§4.40 and 4.59.  Altogether the aforementioned hold about the same probative value as the post-separation VA ROM examination (left ankle dorsiflexion 10 degrees and plantar flexion 30 degrees), which was improved somewhat from prior examinations, but laxity was not addressed.  Additionally, the CI had a normal gait on the NARSUM and VA examinations, which favors moderate rather than marked limitation of motion.  Thus the left ankle condition approximates a “moderate” limitation of motion to support a 10% rating at the time of separation.  The panel considered alternative VASRD ankle and analogous codes (5262, 5270, 5272, 5273), but all were not applicable to the CI’s left ankle condition.  After due deliberation, 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 adjudication for the left ankle condition.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the left ankle 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 20170307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190007845, 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