RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03542
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic left ankle pain secondary to degenerative arthritis” with a disability rating of 0%.  

CI CONTENTION:  Review all conditions.  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 - 20051019	VARD - 20060824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain Secondary to Degenerative Arthritis	5003	0%	Mild Degenerative Changes,  Post-Traumatic Residual, Left Ankle	5010-5271	20%	20060127	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in approximately 1997 and was associated with multiple episodes of ankle sprains and an inversion injury.  An MRI performed in August 2004 demonstrated an increased T2 signal within the body of the talus and no evidence of joint collapse.  He underwent a left ankle arthroscopy on 18 January 2005, which was significant for osteoarthrosis of the right tibiotalar joint and grade III/IV chondral (cartilage) changes involving the talar dome and corresponding aspect of tibia articular cartilage.  The areas with discrete chondral changes were managed with debridement and subchondral drilling.  
At an orthopedic clinic visit on 25 July 2005, the CI reported doing well, with full ankle range of motion (ROM), the ability to do a heel raise, and a normal gait.  Dorsiflexion strength was 5/5 and plantar flexion strength was 4+/5.  During a primary care visit on 8 August 2005, he reported dull, achy left ankle pain but had a normal gait and full ROM.  Strength was normal during dorsiflexion, but was 4+/5 with plantar flexion.  At a 23 August 2005 primary care appointment, 3 months prior to separation, he reported twisting his ankle when walking, and had pain rated at 5/10.  Examination revealed a limping gait with guarding and tenderness of the left ankle.  There was a mild effusion, but no erythema or open areas.  

The 3 October 2005 MEB NARSUM examination, less than 2 months prior to separation, noted CI complaints of recalcitrant left ankle pain and an inability run, jump or walk on uneven terrain.  Activities of daily living were also affected.  Physical examination showed left ankle dorsiflexion to 30 degrees (normal 20) and plantar flexion to 40 degrees (normal 45).  

At the 27 January 2006 VA Compensation and Pension (C&P) examination, less than 2 months after separation, the CI reported stiffness, cracking, and popping on movement.  The examiner found painful motion and swelling with a left ankle circumference of 28 cm compared to 27 cm on the right.  Left ankle ROM measurements showed dorsiflexion to 10 degrees and plantar flexion to 50 degrees.  After multiple repetitions, dorsiflexion ROM decreased to 5 degrees and plantar flexion decreased to 45 degrees, with painful motion.  At a VA primary care clinic visit on 31 July 2006, 8 months after separation, the CI complained of “left ankle pain, stiffness, and weakness resulting in ambulatory dysfunction” and lack of strength.  On examination the left ankle was swollen and tender and had decreased ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, coded 5003 (arthritis, degenerative), citing degenerative arthritis without significant loss of joint motion.  The VA rated the left ankle condition 20%, dual coded 5010-5271 (arthritis, degenerative-ankle, limited motion of), based on the C&P examination, citing marked limited ankle motion.  Panel members agreed that the VA C&P ROM examinations without and with repetition proximate to separation were consistent with the “moderate” limitation of motion required for a 10% rating under code 5271.  The panel did note that on repetition dorsiflexion did decrease to 5 degrees, which raised consideration of a marked limitation of motion; however, plantar flexion after repetition was within normal limits at 45 degrees.  Furthermore, the VA examination was after separation, by almost equal time from separation as the NARSUM was prior to separation.  Therefore, from a probative value analysis, there was no advantage to either examination.  However, there was no explanation of an injury or intercurrent event to explain the loss of motion other than the possibilities of a progressive course of further joint deterioration with time or activity or as a result of the of another undetermined etiology (ligamentous or tendinous) that resulted in swelling of the left ankle.  However, although the VA examination was consistent with DeLuca v. Brown, it was, nevertheless, a post-separation examination with flexion ROM measurements inconsistent with prior pre-separation flexion ROM measurements.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the left 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 the date of medical separation:  
CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Ankle Pain Secondary to Degenerative Arthritis	5271	10%	

 

AR20190008453, 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.