RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02720
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Trainee, medically separated for “right ankle degenerative arthritis” with a disability rating of 10%.  

CI CONTENTION:  In addition to the right ankle condition, 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 - 20090217	VARD - 20090626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Degenerative Arthritis	5003	10%	Right Ankle Fracture 	5271	20%	20090520	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Ankle Degenerative Arthritis.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI underwent right ankle reconstruction surgery in 1999 for a pilon fracture sustained from a motorcycle accident.  The condition was exacerbated following an inversion injury in August 2008.  X-rays revealed minimally decreased tibiotalar joint space with weight bearing.  Hardware alignment was stable and intact without evidence of complication.  

The 7 January 2009 MEB NARSUM examination, 2 months prior to separation, noted complaints of constant right ankle pain with moderate to severe swelling that was usually worse at the end of the day and occasionally caused a tingling sensation in his ankle and foot.  Physical examination showed a severe antalgic gait and ambulation with a cane in the right hand.  There was 2 to 3+ edema about the ankle, mid and hind foot.  The CI had severe tenderness over the distal third of the tibia and fibula; however, he had a negative squeeze test, all compartments were soft and demonstrated appropriate plantar flexion with compression of the gastrocnemius muscle.  Muscle strength testing was normal.  There was subtalar pain with a negative drawer test, but increased pain with tibial tilt.  Right ankle range of motion (ROM), after repetition and measured by goniometer, was limited due to pain and showed dorsiflexion of 0 degrees (normal 20) and plantar flexion of 40 degrees (normal 45).  The unaffected left ankle ROM measurements were dorsiflexion of 15 degrees and plantar flexion of 60 degrees.  

At the 20 May 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported right ankle pain, swelling and difficulty with ambulation.  Physical examination showed the CI walked with an antalgic gait and used a one point cane and CAM walker.  There was bony joint enlargement, crepitus, deformity, edema, tenderness and weakness.  Right ankle ROM after repetitive motion showed dorsiflexion of 1 degree and plantar flexion of 40 degrees.  Painful motion was noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5003 (arthritis, degenerative), citing limitation of motion of a major joint.  The VA rated the right ankle condition 20%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing marked limited motion of the ankle.  The panel agreed that the MEB NARSUM and VA C&P ROM examinations proximate to separation were consistent with the “marked” limitation of motion required for the maximum 20% rating under the 5271 code and ROMs were supported by the presence of an abnormal gait, swelling and crepitus.  There was some retained ankle motion and therefore higher rating under code 5270 (ankle, ankylosis) was not supported.  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 right ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the right 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	
Right Ankle Degenerative Arthritis	5271	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170316, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190006925, 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.