RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02846
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20060620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Traffic Management Coordinator, medically separated for “right ankle, posttraumatic arthritis” with a disability rating of 0%.

CI CONTENTION:  She was not evaluated for multiple conditions rated by the VA.  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 - 20060308	VARD - 20061027	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle…	5010	0%	Status Post Right Ankle Arthroscopic Surgery	5271	10%	20060726	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right Ankle.  According to the service treatment record and MEB narrative summary (NARSUM), the CI outwardly rolled (inverted) her right ankle on 30 April 2004 and sustained a spiral fracture of the fibula.  Despite non-weight bearing, splinting, and physical therapy (PT), the CI’s pain persisted.  An MRI on 1 March 2005 showed good healing of an osteochondral defect fracture of the talus (an ankle bone), which was treated with arthroscopic drilling on 26 September 2005, but subsequently unsuccessful in resolving the pain.  

At the 2 January 2006 MEB NARSUM examination, 6 months prior to separation, the CI reported right ankle pain with the inability to run or stand for prolonged periods or wear her right boot.  Physical examination showed minimal right ankle swelling with the right foot neurovascular status completely intact.  Ankle range of motion (ROM) was dorsiflexion to “90” degrees (normal 20) with the knee extended and plantar flexion “full;” painful motion was present and the gait was mildly antalgic (abnormal due to pain).  During the 24 January 2006 MEB PT evaluation, 5 months before separation, physical examination revealed dorsiflexion to 12 degrees and plantar flexion to 30 degrees (normal 45); painful motion was elicited.

At the VA Compensation and Pension (C&P) general evaluation, 1 month after separation, the CI complained of constant right ankle pain with swelling, redness and give way, but denied incapacitation after the initial injury.  Physical examination revealed no right ankle deformity or ankylosis.  Dorsiflexion was 15 degrees and plantar flexion was 40 degrees with painful motion present, but repetitive use did not decrease ROM.  Neurological findings were normal and an ankle X-ray was negative.  The CI had an antalgic gait but reported recent surgery on the left great toe (bunionectomy).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, coded 5010 (degenerative arthritis due to trauma).  The VA rated the right ankle condition 10%, coded 5271 (ankle, limited motion), based on the C&P evaluation, citing painful motion.  Members agreed that the “moderate” limitation of dorsiflexion supports a 10% rating under code 5271, as recorded on the MEB PT and VA examinations proximate to separation.  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints, no malunion of the os calcis (calcaneus) or astragalus (talus), and no astragalectomy for consideration under the respective diagnostic codes (5270, 5272, 5273 or 5274).  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  However, members agreed that the impairment did not more nearly approximate “moderately severe” to support the next higher 20% rating under this code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right ankle, coded 5271.

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 10%, 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 as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Right Ankle	5271	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170323, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180006113, 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.

Sincerely,					      
Enclosure