RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-03770
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20051108

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “chronic pain, right ankle and right heel” with a disability rating of 20%.

CI CONTENTION: “Tinnitus, right calcaneus fracture, right ankle surgical scan, right knee pain, lower back secondary right knee, PTSD.”  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 - 20050923	VARD - 20070220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Ankle and Right Heel Status Post ORIF of Right Calcaneus Fracture	5284	20%	Status Post Right Calcaneus Fracture	5271	10%	20061012	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Chronic Pain, Right Ankle and Right Heel… According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle and foot condition began in January 2005 when his Humvee was hit by a suicide car bomber and he sustained a closed right calcaneus fracture. In February 2005, the CI underwent an open reduction internal fixation (ORIF) of his calcaneus fracture.  The fracture healed, however, the CI continued to have chronic foot pain.

The 13 July 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic heel pain and lateral ankle pain. Physical examination showed well healed medial and lateral foot wounds. There was “minimal tenderness about the calcaneus” and “minimal pain with subtalar motion.” There was hypersensitivity to light touch along the lateral ankle, with a positive Tinel’s sign (tests for nerve related pain/compression) and tenderness over the peroneal tendons. Ankle range of motion (ROM) was dorsiflexion (DF) of 10 degrees (normal 20) and plantar flexion (PF) of 15 degrees (normal 45) and minimal subtalar motion. Ankle X-rays showed healed calcaneus fracture with intact hardware and minimal subtalar arthritis.

Evaluation at a physical therapy examination on 19 July 2005 showed DF of 10 degrees and PF of 20 degrees. There was no tenderness. At the 27 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, physical examination showed mild swelling of the anteromedial aspect of the ankle. Plantar flexion elicited pain and gait was normal.

At the 12 October 2006 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported constant right ankle and heel pain with weakness, swelling and stiffness. He denied instability, giving way, fatigability, or lack of endurance. He reported flare- ups usually occurred twice per month and lasted for a couple minutes. Pain was increased by standing and walking. The CI had not missed any work in the past 12 months due to the condition. Physical examination showed an antalgic gait favoring the right lower extremity. Right ankle ROM was DF of 15 degrees and PF of 40 degrees, with painful motion. There was no additional limitation of motion after repetition and no swelling. Flat foot was noted and the arch and medial and lateral aspects of the ankle were tender. Circulation and sensation were intact. The CI was able to stand, squat, and rise on toes and heels without difficulty. There was bilateral valgus deformity of the Achilles tendons (ATs) that corrected with non-weight bearing and the ATs were non-tender.  Forefoot and midfoot alignment were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle/heel condition 20%, coded 5284 (other foot injury), citing moderately severe foot injury. The VA rated the ankle/heel condition 10%, coded 5271 (limitation of ankle motion) based on the C&P examination, citing moderate limited motion of the ankle.

A 20% rating was supported for moderately severe foot injury coded 5284 based on an antalgic gait with painful motion at all examinations proximate to separation requiring occasional use of a brace, but not requiring use of any assistive device for ambulation. Panel members agreed the CI’s foot injury did not rise to the severe level for a higher rating under code 5284. The panel considered other VASRD foot and ankle codes and all were less applicable/or not advantageous for rating. There was no higher rating supported than 20% under any applicable code. 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/heel condition.

BOARD FINDINGS:  In the matter of the chronic right ankle and right heel pain    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.

The following documentary evidence was considered:

		PD-2017-03770

AR20190012665, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX

	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.

	PD-2017-03770