RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03359
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20071115

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Infantryman, medically separated for “right fibula fracture, right ankle pain and right ankle ankylosis” with a disability rating of 10%.

CI CONTENTION: “Combat injuries overseas OEF 05/06, medical discharge.” 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 - 20070927	VARD - 20080721	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Fibula Fracture, Right Ankle Pain and Right Ankle Ankylosis	5271	10%	Right Distal Fibula Fracture Residuals	5271	20%	20081004	
Post-Traumatic Stress Disorder (PTSD)	
Not Unfitting	PTSD	9411	30%	20080505	
Post-Concussive Syndrome		Post-Concussive Syndrome	8099-8045	10%	20080507	
Positional Vertigo		No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Right Fibula Fracture, Right Ankle Pain and Right Ankle Ankylosis. According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured his right fibula in May 2006 when a rocket propelled grenade landed 100 meters away knocking the CI to the ground while he was carrying/retrieving his battle buddy during a firefight in Afghanistan.  The fracture

was surgically repaired, and it healed; however, he had a noticeable limp and was noted to have some evidence of calcification. The CI subsequently underwent another surgery in October 2006 followed by removal of two surgical screws in January 2007. Status post physical therapy (PT) and a home exercise program did not resolve the right ankle pain and limited motion.

During the 24 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, physical examination revealed the CI’s inability to right foot tiptoe or heel walk. There was right ankle swelling, and the talar drawer test for ankle instability was negative. Sensory testing was intact. Right ankle limitation of motion was present especially with dorsiflexion. At the 30 May 2007 MEB Sports and PT Associates examination, 6 months prior to separation, goniometric-measured repetitive right ankle dorsiflexion was 8 degrees (normal 20) and plantar flexion was 30 degrees (normal 45). Limitation of motion was due to mechanical limitation and muscle contractures. During the 18 June 2007 MEB NARSUM examination, 5 months prior to separation, the examiner referenced the aforementioned MEB examination and MEB Sports and PT Associate physical examination findings.

At the 9 May 2008 VA Compensation and Pension (C&P) general examination, 6 months after separation, the CI reported right ankle pain and stiffness. Physical examination revealed a normal gait and no right side sensory loss. At the VA C&P joints examination one week later the CI reported right ankle pain and stiffness and loss of both dorsiflexion and plantar flexion. Pain increased when he walked any distance. Physical examination revealed a mild right antalgic gait. Right leg muscles strength was 4/5 (slight decrease). The right ankle dorsiflexed to “90 degrees actively,” and plantar flexion was 30 degrees.  Painful motion was not addressed.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the right fibula and ankle condition 10%, coded 5271 (ankle, limited motion). The PEB cited moderate limitation of motion and the VA based the rating on the C&P joints examination, citing moderate limitation of motion. The panel agreed that the MEB Sports and VA ROM examinations were consistent with “moderate” ankle limitation of motion to support a 10% rating under code 5271. There was no ankylosis (5270), or nonunion or malunion (5262) to support a higher 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 right fibula and ankle condition.

Contended PEB Conditions: Post-Traumatic Stress Disorder, Post-Concussive Syndrome, and Positional Vertigo. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. None of the contended conditions were profiled. The commander’s statement documented the CI’s ability to: work administrative support for 40 hours per week, remember locations and work instructions, maintain attention and concentration, complete work tasks in a timely manner, communicate with others, relate civilly to supervisors and workers, work with and near others without being unduly distracted, make simple work-related decisions, and ask questions and request help when appropriate. The psychiatric addendum to the MEB documented the CI was psychiatrically fit for military duty. The contended conditions did not fail retention standards. There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the right fibula and ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended post- traumatic stress disorder, post-concussive syndrome, and positional vertigo conditions, the panel

recommends no change from the PEB determinations as not unfitting. 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:

PD-2017-03359
, XXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

	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.

Enclosure

PD-2017-03359