RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03761
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080910

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E2, Trainee, medically separated for “right talus fracture” with a disability rating of 10%.    

CI CONTENTION:  “Arthritis makes the foot and knees immobile.” 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 – 20080827	VARD - 20090202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Talus Fracture	5284	10%	Status Post Right Ankle Fracture 	5271	20%	20081121	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Right Talus Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began in March 2008 while participating in urban operations training.  X-rays showed a talar body fracture with comminution in the medial aspect of the talar neck body junction.  The CI underwent an open reduction and internal fixation.   Range of motion (ROM) measurements were completed on 17 July 2008 by physical therapy (PT).  Right ankle ROM following repetition showed dorsiflexion of 6 degrees (normal 20) and plantar flexion of 55 degrees (normal 45) with pain at end range.  

The 7 August 2008 MEB NARSUM examination, 1 month prior to separation, noted complaints of continued pain with every step which increased when maneuvering stairs.  Physical examination showed that the CI wore a Cam walker with an antalgic gait.  Incisions were well-healed and non-tender.  Sensation was intact.  The examiner referred to the PT ROMs noted above.  

At the 21 November 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continued pain, decreased ankle ROM and right knee pain secondary to pain in the right ankle.  Physical examination showed a slight limp.  There was no effusion.  Right ankle ROM showed dorsiflexion of 0 degrees and plantar flexion of 40 degrees with painful motion but no further loss of motion with repetitive use.  Right knee ROM was flexion of 111 degrees (normal 140) and extension of 0 degrees (normal).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5284 (foot injuries, other), citing moderate disability.  The VA rated the right ankle condition 20%, coded 5271 (limited motion of the ankle), based on the C&P examination, citing marked limited motion of the ankle.  The panel considered if the limitation of motion was “moderate” or “marked” when considered under 5271.  The panel majority agreed that the ROM examinations proximate to separation noted limitation of dorsiflexion to 30% or less which is consistent with the “marked” limitation of motion required for the maximum 20% rating under this code.  Because there was no ankylosis (5270), nonunion or malunion (5262), 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 approximate “severe” to support the next higher 30% 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 20% for the right ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the right 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 but 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	
Right Talus Fracture	5271 	20%	

The following documentary evidence was considered:

AR20180015893, 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.