RECORD OF PROCeediNGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02687
BRANCH OF SERVICE:  army	SEPARATION DATE:  20080126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O3, General Aviation Officer (Black Hawk Pilot), medically separated for “chronic pain and decreased range of motion (ROM) of the right ankle” with a disability rating of 10%.  

CI CONTENTION:  Review requested of ankle condition, which continued to worsen after separation, and 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 - 20071026	VARD - 20080328	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain…Right Ankle	5271	10%	Status Post Fracture, Right Ankle and Fibula…	5262-5271	10%	20071128	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record (STR) and MEB NARSUM and, the CI underwent an open reduction internal fixation surgery in February 2006 to repair a right ankle (distal fibula) fracture following a helicopter crash (screw removal was performed in May 2006).  Postoperative physical therapy (PT) was beneficial, but he subsequently experienced persistent right ankle crepitus and occasional pain and soreness after increased activity.  A CT scan showed a stage 4 talar dome osteochondral lesion. Although the CI was able to return to flying duties, he was not able to run, ruck or carry gear.
At an orthopedic examination on 9 May 2007, 9 months before separation, the CI reported some right ankle stiffness after working out.  Physical examination showed no ankle laxity (anterior draw and talar tilt tests) or tenderness, and the provider documented dorsiflexion to 15 degrees (normal 20) and plantar flexion to 35 degrees (normal 45), noting the CI  did “not have pain with forced dorsiflexion.” 

The 24 May 2007 MEB PT examination, 8 months prior to separation, documented painful right ankle motion, with goniometrically measured ROM showing dorsiflexion to 5 degrees and plantar flexion to 30 degrees.  The 7 June 2007 MEB examination (recorded on DD Forms 2807-1 and 2808) recorded right ankle tenderness and “full” ROM with no mention of painful motion.  The 20 August 2007 MEB NARSUM examination, 5 months prior to separation, documented well-healed surgical incisions, and no tenderness, instability, or neurovascular deficits.  The examiner repeated the MEB PT measurements and diagnosed right ankle osteochondral lesion of the talus.  

At the 28 November 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI complained of throbbing, dull right ankle pain with stiffness, locking, and instability.  He had weekly flare-ups precipitated by inactivity that subsided spontaneously, and used no assistive devices to ambulate.  Physical examination revealed a normal gait and heel and toe walking, with full weight bearing and no foot callosities, breakdown, or unusual shoe wear patterns.  There was tenderness, but no edema, effusion, or instability, and right ankle dorsiflexion strength against resistance was normal.  Dorsiflexion was to 10 degrees and plantar flexion to 30 degrees, with painful motion and loss of ROM following repetition (not quantified). 

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 moderate limited motion.  The VA also rated the right ankle condition 10%, coded 5271, citing moderate limited motion.  Members considered if the ankle limitation of motion rose to a “marked” level to support the next higher 20% rating under code 5271, but agreed that the preponderance of STR and VA evidence, most proximate to separation, documented a moderate limitation.  The panel considered alternative VASRD ankle and analogous codes (5262, 5272, 5273), but all were less applicable and/or not advantageous to rating.  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.  

BOARD FINDINGS:  In the matter of the right 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 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190007070, 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.