RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02795
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Armament Electronics and Avionics Systems Specialist, medically separated for “left ankle pain” with a disability rating of 10%.  

CI CONTENTION:  “It was known that another surgery would be needed to repair ankle.”  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 - 20081024	VARD - 20090611	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5099-5003	10%	Left Ankle S/P Bostrum Procedure 	5271	20%	20090522	
Generalized Anxiety Disorder	Not Unfitting	Posttraumatic Stress Disorder	9411	30%	20090821	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent ankle stabilization surgery in October 2005.  Despite initial improvement in symptoms, the ankle pain returned and persisted.  A Podiatry examination in March 2008 noted full range of motion (ROM) of the left ankle.  

The 1 August 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of left ankle pain, exacerbated by cold weather.  The physical examination (PE) revealed a “normal ankle and basic gait.”  Peripheral strength of the extremities was normal.  Left ankle ROM, following repetition, noted dorsiflexion of -12 degrees (normal 20) and normal plantar flexion.  Painful motion was present.  

At the 22 May 2009 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant pain in his left ankle which got progressively worse throughout the day.  The CI claimed he utilized an ankle brace but still had difficulty with prolonged standing or walking.  His PE revealed an antalgic gait.  Ankle tenderness was present.  “Left ankle ROM revealed no dorsiflexion, as the [CI was] unable to get to 90 degrees or neutral position.”  Laxity within the left ankle joint was not present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, analogously coded 5099-5033 (arthritis, degenerative), citing limitation of motion of one major joint.  The VA rated the left ankle condition 20%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing marked limitation of motion of the ankle.

Panel members considered the NARSUM measurement of negative (-) 12 degrees of dorsiflexion and noted it was inconsistent with the usual and customary or conventional medical documentation; however, such a negative description was consistent with the 5 month post-separation VA examination whereby it was further explained that the CI had no dorsiflexion and that he was unable to get his left foot to a neutral or 90 degree position.  In other words, in a neutral position, the CI’s left foot is bent 12 degrees towards the ground.  This condition would indeed cause an antalgic gait, which was apparent.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that the degree of limited motion of the left ankle was greater than “moderate” and more appropriately described as “marked” impairment to support a rating of 20%.  

Contended PEB Condition:  Generalized Anxiety Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the left ankle condition, the panel recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  In the matter of the contended generalized anxiety disorder, the panel recommends no change from the PEB determination as not unfitting.  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 Pain	5271	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190008417, 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.