RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02704
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070508

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “left ankle osteochondral defect” with a disability rating of 0%.  

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 - 20070426	VARD - 20071213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Osteochondral Defect	5099-5003	0%	Left Ankle Osteochondral Defect 	5271	10%	20071101	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Ankle Osteochondral Defect.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in August 2006 after a 16 foot jump from a cargo net during basic training.  He had a traumatic left ankle inversion sprain and was placed in a cast.  On 2 February 2007 (3 months prior to separation) the CI had left ankle arthroscopic surgery to remove a large loose body bone fragment.  

The 29 March 2007 MEB NARSUM examination, 1 month prior to separation, noted complaints of left ankle pain.  Physical examination showed the CI stood and walked with a left limp and there was tenderness of the left ankle.  The ankles appeared normal and there was no redness, swelling, heat or effusion.  Range of motion (ROM) testing showed dorsiflexion of 0 degrees (normal 20) and plantar flexion of 30 degrees (normal 45) limited by pain.  An additional ROM study within the NARSUM (likely erroneously reversed dorsi vs plantar) showed dorsiflexion of 41 degrees and plantar flexion of -3 degrees with pain at the extremes of motion.  

During the 12 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month prior to separation, the CI reported left ankle pain and swelling.  Physical examination showed decreased left ankle ROM in all planes of movement with weakness and tenderness; however, no measurements were recorded.  

At the 1 November 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported pain with walking and was not able to run.  Physical examination showed mild limping of the left leg without assistive devices.  Left ankle ROM testing showed dorsiflexion of 17 degrees and plantar flexion of 36 degrees.  There was increased pain, fatigability and lack of endurance with repetitive motion, but no change in ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing mild limitation of motion due to pain an no “mechanical” loss of motion, with likely application of AR 635-40, B-29, in effect at the time.  The VA rated the left ankle condition 10%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing moderate limited motion of the ankle.  The panel deliberated on the probative value of the examinations in evidence.  The NARSUM examination was closest to separation and had the highest probative value for rating at separation.  The C&P examination was adjudged as showing post-separation improvement.  The panel adjudged the limitation of motion, at the time of the MEB NARSUM examination, most nearly approximated the “marked” degree of limitation consistent with the 20% rating under diagnostic code 5271.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a higher rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the left ankle condition, the panel recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Ankle Osteochondral Defect	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170319, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190006923, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.