RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02942
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090219

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Heavy Construction Equipment Operator, medically separated for “left ankle loss of motion” with a disability rating of 10%.  

CI CONTENTION:  The condition continues to worsen and negatively affects daily activities.  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 - 20090121	VARD - 20090429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Loss of Motion	5271	10%	Left Ankle Strain	5271	10%	20090407	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Ankle Loss of Motion.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a Broström repair of the left ankle in August 2008.  A post-surgical MRI in October 2008 showed mild thickening of the anterior talofibular ligament.  The 21 November 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic left ankle pain and instability.  Physical examination showed the neurovascular status of the lower extremities to be intact.  There was tenderness at the left lateral ankle area around the anterior talofibular ligament and at the posterosuperior aspect of the calcaneus where the Achilles tendon inserts.  He had pain to the left ankle joint with range of motion (ROM).  He had minimal anterior drawer and talar tilt and his gait was mildly antalgic on the left.  

At the time of the physical therapy (PT) clinic appointment on 10 December 2008, 2 months prior to separation, the CI reported left ankle pain and instability.  Left ankle ROM after repetition showed dorsiflexion of 17 degrees (normal 20) and plantar flexion of 36 degrees (normal 45); painful motion was noted.  Left ankle ROM measurements performed by PT 5 days later showed dorsiflexion of 10 degrees and plantar flexion of 40 degrees, after repetitive motion; painful motion was noted.  

At the 7 April 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported left ankle pain, weakness, stiffness, instability, giving way, and lack of endurance.  The CI wore a brace for support and stability.  Physical examination showed a normal gait.  Left ankle ROM, after repetitive motion, showed dorsiflexion of 20 degrees and plantar flexion of 45 degrees.  There was no pain on motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and the VA rated the left ankle condition 10%, coded 5271 (ankle, limited motion). The PEB cited moderate loss of motion.  The VA based the rating on the STR and C&P examination, citing moderate limited motion of the ankle.  The panel considered if the limitation of motion was “moderate” or “marked” when considered under 5271.  The panel agreed that the ROM examinations proximate to separation were consistent with the “moderate” limitation of motion required for the 10% rating under this code, and were supported by the presence of painful motion.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 10% rating adjudicated by the PEB.  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 left ankle condition.  

BOARD FINDINGS:  In the matter of the left ankle condition 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 20170328, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190007216, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.