RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03558
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070724

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Cavalry Scout, medically separated for “…chronic pain of the left ankle” with a disability rating of 10%.  

CI CONTENTION:  Review requested of an additional left knee condition 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 - 20070405	VARD - 20080721	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain of the Left Ankle	5271	10%	Chronic Left Achilles Tendonitis Secondary to a Partial Achilles Tear, Left Leg	5284	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained a partial tear of the Achilles tendon in 2003 while playing basketball.  The 16 January 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of an inability to run, walk or stand for prolonged periods.  Physical examination showed tenderness over the distal Achilles tendon with thickening of the cord, but no deformity, effusion or warmth.  The examiner noted full, active ankle range of motion (ROM) with discomfort at the extremes.  Motor and sensation were intact distally with 5/5 (normal) strength.  
During the 6 February 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months before separation, physical examination revealed Achilles tendon tenderness and an abnormal gait with an inability to push off with the left foot.  There was also gastrocnemius atrophy and plantar flexion weakness (4-/5).  The 9 February 2007 MEB NARSUM addendum noted complaints of constant pain.  Physical examination showed dorsiflexion of minus 5 degrees (normal 20) and plantar flexion of 50 degrees (normal 45) after repetitive motion.  The examiner noted moderate weakness (4-/5) during plantar flexion.  

At a physical medicine appointment on 17 March 2007, 4 months before separation, the examiner noted left calf (gastrocnemius and soleus) muscle atrophy.  The Achilles tendon was tender and plantar flexion strength was 4/5 with end range pain.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5271 (ankle, limited motion of), citing left plantar flexion at “80%”of the right ankle,” and measurements not limited by pain.  The VA rated the left ankle condition 0%, coded 5284 (foot injuries, other), based on the STR, citing a non-compensable evaluation assigned for an injury to the foot in the absence of evidence of moderate symptoms; for hammertoe of single toes; for slight claw foot; for pes planus (flat foot) which is mild with symptoms relieved by built-up shoe or arch support.  Panel members first agreed that the MEB addendum examination was closest to separation and had the highest probative value for rating at separation.  The limitation of motion at the time of the MEB examination was consistent with the “marked” limitation of motion required for the maximum 20% rating under diagnostic code 5271.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a higher rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the left ankle condition, the panel majority recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  The single voter for dissent recommends no change and did not elect to submit a minority opinion.  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 Pain of the Left Ankle	5271	20%	

AR20190008464, 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 to 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,