RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03540
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20081018

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Medical Logistics Specialist, medically separated for “left ankle pain” with a disability rating of 10%.  

CI CONTENTION:  “Overall VA rating 60%.  I get 10% for my left eye scar but nothing for any of the injuries that it was caused from.  I also get nothing for my back because my ankle caused it, but I have to live with it the rest of my life.”  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 - 20080716	VARD - 20091123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5099-5003	10%	Left Ankle Trauma	5271	10%	20081114	
Low Back Pain	Not Unfitting	Low Back Strain 	5237	0%	20091102	
Left Orbital Floor Fracture	Not Unfitting	Scar, Left Lower Eyelid	7800-7804	10%	20091102	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  	

Chronic Left Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent ankle stabilization on 27 April 2007.  She was improving slowly in rehabilitation until she again sprained her ankle in early November 2007.  A repeat MRI showed tears of several ligaments.  She had a revision of the ankle stabilization on 31 January 2008.  This was followed by rehabilitation in physical therapy.  Although she had improved function, her ankle pain persisted.  

In physical therapy on 7 April 2008, 6 months prior to separation and 2 months after the second operation, the CI had well-healed but tender scars from the surgeries.  Her strength was 4+/5.  Range of motion (ROM) testing showed dorsiflexion (toes up) of 10 degrees (normal 20) and plantar flexion (toes down) of 35 degrees (normal 45).  Later that month in podiatry, she was noted to have a well-healed incision site with tenderness.  The strength was now normal (5/5) and dorsi-flexion was greater than 10 degrees.  In physical therapy on 5 April 2008, she was noted to have normal strength and full ROM.  On 29 May 2008, in podiatry, she was found to be full weight bearing with normal strength and a stable ankle.  

The 11 June 2008 MEB NARSUM examination, 4 months prior to separation and 4 months after surgery, noted complaints of chronic left ankle pain and subjective instability.  She noted benefit from her ankle brace and the wear of Army boots.  The physical examination showed left ankle ROM, following repetition, of dorsiflexion to 6 degrees and plantar flexion to 35 degrees.  However, the uninjured right side showed dorsiflexion of 10 degrees and plantar flexion of 35 degrees.  The ankle was stable and the scar was well healed and non-tender.  Gait was basically normal except for very slight antalgic gait (abnormal due to pain) noted intermittently.  There was pain on repeated ROM and a 5 degrees impairment on eversion due to a mechanical block from her ankle stabilization procedure.  

The CI was seen in podiatry on 4 August 2008 and reported a repeat sprain 10-14 days earlier; she was not wearing her ankle brace at that time.  On examination, she was wearing her ankle brace and was full weight bearing, but favored the left ankle.  Her strength remained normal and the ankle was stable.  

At the 14 November 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported continued ankle pain and pain in the back of the heel.  The physical examination showed normal gait and strength.  Ankle motion was painful.  The ROM was recorded as dorsiflexion of 90-80 degrees and plantar flexion of 90-50 degrees after repetition.  [The panel thought that this represented measurements of 10 degrees of dorsi-flexion and 40 degrees of plantar flexion, but it is not clear what the measurements actually meant and, accordingly, these were not used for rating purposes.]  There was additional tenderness, instability and weakness of the ankle and foot.  X-ray images showed the expected post-surgical changes.  

During a VA primary care clinic visit on 22 December 2008, 2 months after separation, the CI was not wearing the ankle brace as it did not fit correctly.  No additional injury since separation was recorded.  The physical examination showed a normal gait and ROM.  Some laxity of the ankle was noted with inversion rotation.  [This had not been observed on the podiatry examinations prior to separation.]  There was slight tenderness over left ankle lateral malleolus region.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, analogously coded 5009-5003 (arthritis, degenerative), citing limitation of motion.  The VA also rated the left ankle condition 10%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing limitation of motion with pain.  The panel concurred that a 10% rating for functional loss (§4.40, §4.45, §4.59) due to instability and pain was appropriate, as adjudicated by the PEB.  The panel considered if the limitation of motion was “moderate” or “marked” when considered under 5271, limitation of ankle motion.  The panel agreed that the ROM examinations proximate to separation were consistent with the “moderate” limitation of motion required for a 10% rating under this code.  The VA evaluations 1 and 2 months after separation were the most remote from surgery; both showed a normal gait.  The 5271 code better described the clinical limitation, but provided no advantage to the CI.  After due deliberation, considering all of 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.  

Contended PEB Conditions:  Low Back Pain and Left Orbital Floor Fracture.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement.  Both were judged to meet retention standards.  There was no performance-based evidence from the record that either 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 either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended low back condition and left orbital floor fracture, 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:

Exhibit A.  DD Form 294, dated 20170508, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180009201, 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.

Sincerely,					      
Enclosure