RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02836
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051028

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Engineering Craftsman, medically separated for “left ankle pain and stiffness status post (s/p) lateral ankle reconstruction” with a disability rating of 10%.   

CI CONTENTION:  Review of all conditions requested.  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 - 20050830	VARD - 20051121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5299-5271	10%	S/P Left Ankle Lateral Retinacular Release and Stabilization Surgery	5271	10%	20051003	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent left ankle surgery in February 2003 for lateral ligament reconstruction following a talofibular ligament tear due to a twisting injury.  Shortly after surgery the pain recurred and in March 2004 a second surgery (anterior retinacular release) to excise scar tissue and a retained suture was performed.  The ankle pain again recurred shortly after surgery and additional surgery was not considered an option for relief.  In spite of treatment, the ankle continued to prevent the CI from fully performing the duties of his specialty.  

At the 24 March 2005 physical therapy appointment, 7 months prior to separation, the CI reported persistent pain around the left ankle, rated at 7/10.  Physical examination showed full range of motion (ROM) with pain at the end range of all planes.  There was tenderness and some weakness noted.  The examiner noted there was no ligamentous laxity.  Radiographic studies (X-rays) on 13 April 2005 were negative other than the presence of post-operative screws.  The 23 June 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of significant ankle pain and disability to the point where the CI was no longer able to do his regular job.  Physical examination showed a normal gait with diffuse tenderness.

At the 3 October 2005 VA Compensation and Pension (C&P) examination, 3 weeks before separation, the CI reported constant symptoms of pain and stiffness in the ankle with reduced ROM.  Physical examination showed a normal gait and posture without signs of abnormal weight bearing.  There was no effusion, swelling, redness, or heat.  Ankle ROM was dorsiflexion to 20 degrees (normal) and plantar flexion to 35 degrees (normal 45), limited by pain and post-surgical stiffness.  The panel noted the CI underwent another surgical intervention on 1 March 2006, 4 months after separation, for diffuse anterior left ankle debridement, thus mitigating the probative value of any subsequent post-separation evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition 10%, analogously coded 5271 (ankle, limited motion).  The VA rated the S/P left ankle lateral retinacular release and stabilization surgery condition 10%, coded 5271, based on the C&P examination, citing a history of treatment and functional loss due to reduced ROM.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However there was evidence of painful motion causing functional loss supporting the 10% rating (based on §§4.59, 4.40 and 4.45).  The panel concurred that a 10% rating for functional loss due to pain was appropriate, as adjudicated by the PEB.  The panel considered alternative VASRD ankle and analogous codes, 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 ankle condition.  

BOARD FINDINGS:  In the matter of the left ankle pain 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 20170425, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02836.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.