RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03513
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050610

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Field Artillery Firefinder Radar Operator, medically separated for “chronic left ankle pain” with a disability rating of 0%.   

CI CONTENTION:  The CI requested review of an additional condition (PTSD) 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 - 20050518	VARD - 20050915	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5024	0%	Residuals, Left Achilles Tendon Reconstruction	5024-5271	10%	20050823	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left ankle surgery on 11 February 2004 for Achilles tendon laceration and repair.  At the time of the physical therapy clinic appointment on 4 May 2004, 13 months prior to separation, the CI reported left ankle discomfort and wore a boot.  Range of motion (ROM) measurements showed a normal dorsiflexion of 20 degrees and a plantar flexion of 50 degrees (normal 45).  At the time of an orthopedic clinic appointment on 17 November 2004, 7 months prior to separation, the CI reported continued pain and stiffness.  Physical examination showed mild erythema, decreased light to touch on the lateral aspect of the foot, normal reflexes, and negative Thompson test used to test the Achilles.  ROM measurements showed a normal dorsiflexion and a plantar flexion of 30 degrees.  

The 22 April 2005 MEB NARSUM, 2 months prior to separation, noted continued pain in the left ankle.  Physical examination showed the incisions were well healed without any surrounding erythema or drainage.  There was decreased light touch on the lateral aspect of the foot.  Muscle strength was normal, pulses were intact, and there was a negative Thompson’s test.  ROM measurements with a goniometer showed a normal dorsiflexion of 20 degrees and a plantar flexion of 20 degrees.  There was no evidence of painful motion or abnormal gait reported.  

At the 23 August 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported his ankle ached all the time.  Physical examination showed a normal gait.  The left calf muscle showed atrophy; there were normal reflexes, normal sensation, normal strength, and no tenderness.  ROM measurements showed a normal dorsiflexion and a plantar flexion of 30 degrees.  There was no evidence of painful motion reported.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, coded 5024 (tenosynovitis), citing without loss of motion.  The VA rated the left ankle condition 10%, dual coded 5024-5271 (tenosynovitis-ankle, limited motion), citing moderate limited motion of the ankle.  

The MEB and C&P examinations recorded normal dorsiflexion with a normal gait but loss of plantar flexion, which supported a 10% rating for “moderate” limitation of motion (5271 ankle, limited motion).  A higher rating of 20% was not indicated in the absence of “marked” limited ROM of the ankles.  The panel agreed that the preponderance of the ROM evidence most closely approximated “moderate” limitation of motion for a 10% rating under diagnostic code 5271.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  Because there was no ankylosis, nonunion, or malunion, VASRD §4.71a offers no applicable joint code which would yield a higher rating.  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  However, all panel members agreed that the impairment did not more nearly approximate “moderately severe” to support a 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 left ankle condition, coded 5024-5271.  

BOARD FINDINGS:  In the matter of the chronic left ankle pain condition, the panel recommends a disability rating of 10%, coded 5024-5271 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Ankle Pain	5024-5271	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170403, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005932, 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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure