RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03586
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050407

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 “decreased range of motion and pain in the right ankle and subtalar joint” with a disability rating of 20%.  

CI CONTENTION:  No specific contention was made.  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 - 20050211	VARD - 20050913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Decreased Range of Motion (ROM) and Pain in the Right Ankle and Subtalar Joint	5271	20%	Right Ankle Gunshot Wound Status Post Open Arthrotomy…	5010-5271	10%	20050826	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Decreased ROM and Pain in the Right Ankle and Subtalar Joint.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began on 11 November 2003 when a bullet entered the top of his foot and exited through the heel while performing guard duty in Iraq.  He was medically evacuated and eventually returned to his home station of Ft. Bragg.  He continued to have significant pain and decreased ambulation and ROM after physical therapy.  An MRI in April 2004 showed suspicion of subtalar intra-articular loose bodies.  Significant signal abnormality far from the injury site raised the possibility of chronic inflammation to include infection of the talus and calcaneus.  X-rays in May 2004 showed post-traumatic changes within the calcaneus consistent with the gunshot wound and increased calcaneus bone mineralization.  Subtalar and ankle mortise joints appeared normal.  

During the 14 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported right ankle and foot pain which was exacerbated by walking or prolonged standing.  Physical examination revealed a 2 cm right ankle linear scar with mild diffuse swelling on the plantar aspect of his heel over the exit wound.  Decreased ROM was noted in both the subtalar and ankle joints with notable crepitus and grinding during inversion and eversion.  Ankle dorsiflexion strength was 4/5 and there was plantar exit wound and subtalar joint tenderness.  Goniometric measured ROM was dorsiflexion to 4 degrees (normal 20) and plantar flexion was 12 degrees (normal 45); painful motion was not addressed.  The 1 November 2004 MEB NARSUM examination, 5 months prior to separation, captured similar physical examination findings.  

At the 26 August 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported morning stiffness with flare-ups once or twice a month.  The examiner noted the CI had undergone an open arthrotomy in May 2005, shortly after discharge, for removal of two loose bodies, and “has done pretty well since then.”  Physical examination showed dorsiflexion to 15 degrees and plantar flexion was 30 degrees; painful motion was elicited.  Repetitive motion did not decrease ROM.  Right ankle X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, coded 5271 (ankle, limited motion), citing decreased subtalar and ankle joint ROM.  The VA rated the right ankle condition 10%, dual coded 5010-5271 (arthritis, due to trauma-ankle, limited motion), based on the C&P examination, citing painful motion.

The panel noted that the PEB assigned the maximum 20% rating available under diagnostic code 5271.  The panel also considered VASRD code 5284 (foot injuries, other) but agreed the CI’s condition did not support the 30% “severe” 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 ankle condition.

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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.

AR20180015307, 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.