RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02564
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “chronic bilateral ankle pain” with a disability rating of 20%.  

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 - 20080804	VARD - 20090403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Ankle Pain	5099-5003	10%	Status Post Lateral Ligament Repair, Right Ankle	5299-5271	10%	20081015	
		10%	Status Post Lateral Ligament Repair, Light Ankle	5299-5271	10%	20081015	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Bilateral Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right ankle stabilization surgery in May 2007 and left ankle stabilization surgery in November 2007.  The 13 June 2008 MEB podiatry examination, 6 months prior to separation, noted complaints of chronic ankle pain.  Physical examination showed normal strength in all planes of motion of both ankles, as well as normal range of motion (ROM).  There was tenderness over the anterior talofibular ligament of both ankles with no overlying swelling or erythema.  The examiner noted a negative drawer test on the right and minimal positive drawer on the left, consistent with residual instability.  There was pain in both ankles on inversion.  All other aspects of the examination were within normal limits.  Right and left ankle X-rays showed no visible fracture or other bony injury and the articular surfaces of the joints were normal in appearance.  

The 23 June 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of pain with high impact activities, walking greater than a quarter mile and standing greater than 20 minutes.  The CI also complained of ankle instability and occasionally wore ankle braces.  Physical examination showed a normal gait.  There was mild tenderness to both ankles laterally, without swelling or instability.  The CI had mild pain with eversion and inversion with “good endpoint bilaterally.”  The MEB physical therapy ROM study on 3 June 2008 showed, after repetition, left ankle dorsiflexion of 4 degrees (normal 20) left ankle plantar flexion of 39 degrees (normal 45), right ankle dorsiflexion of 3 degrees and right ankle plantar flexion of 38 degrees with painful limitation of motion.  

At the 15 October 2008 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI reported use of ankle braces and complained of continued chronic ankle pain with any significant standing.  Physical examination showed mild swelling over the lateral ligaments and mild tenderness of both ankles.  The lateral ligaments were intact when stressed, but there was a bilateral mild to moderate positive drawer sign.  The examiner noted the ankles had moderately severe lack of endurance, no lack of coordination and moderate restriction of repetitive use.  Ankle ROM testing showed bilateral dorsiflexion of 20 degrees and bilateral plantar flexion of 20 degrees with mild pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated each ankle 10%, analogously coded 5003 (arthritis, degenerative), citing evidence of painful motion.  The VA also rated the each ankle condition 10%, analogously coded 5271, based on the C&P examination, citing painful motion and no evidence of marked limitation of motion bilaterally.  

There are no distinctions with regards to clinical features or fitness considerations between the right and left ankles and members agreed the respective ratings should therefore be the same.  The panel agreed that the ROM of both ankles at the VA examination most proximate to separation were consistent with the “moderate” limitation of motion required for the 10% rating under code 5271 and not “marked” as required for the 20% rating.  The panel also considered whether a higher rating was supported for either ankle under alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  Although the panel arrived at its rating recommendation utilizing a different code than the PEB, it provides no ratings benefit to the CI and therefore no change to the PEB’s coding choice is recommended.  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 and left ankle conditions.  

BOARD FINDINGS:  In the matter of the bilateral ankle conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudications.  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 20170327, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190006081, 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.