RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03839
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Radiology Specialist, medically separated for “chronic right ankle pain with instability” with a disability rating of 10%.  

CI CONTENTION:  “During my time in service I continually complained about my back and my knees as well as other injuries I received in service, yet I was only Med Boarded for my ankle.” 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 - 20040916	VARD - 20050427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain, Instability	5099-5003	10%	Chronic Right Ankle Sprain	5271	10%	20050127	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain, with Instability.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured his ankle in November 2001 during basic training and complained of persistent pain and instability.  X-rays and an MRI demonstrated a possible remote avulsion fracture (lateral malleolus) and ligamental injury (posterior tibiofibular), but no other positive findings.  An orthopedic consultant found the ankle to be grossly stable to stress testing, could not correlate the “very minimal findings” with the “true source of his dysfunction,” and recommended conservative treatment.  There was evidence of failure to follow through with recommended physical therapy.  

A repeat orthopedic evaluation on 22 June 2004, 5 months before separation, again confirmed the ankle as grossly stable to stress testing and documented active plantar flexion (PF) to 40 degrees (normal 45).  Active dorsiflexion (DF) was guarded at minus 20 degrees secondary to pain (normal is positive 20), although passively the joint could be dorsiflexed to a neutral 0.  The orthopedist opined that surgical intervention was not indicated and recommended an MEB.   This examination provided the only service range of motion (ROM) evidence available in this case.  Other examiners noted painful motion without comment regarding ROM limitation.  There was no evidence in outpatient STR entries for gait disturbance (due to the ankle), objective instability, use of an ankle brace, or VASRD-ratable findings.  The MEB’s DD Form 2808 physical examination on 19 July 2004, 4 months before separation, however, recorded “lateral instability” and joint tenderness.  The 19 August 2004 MEB NARSUM examination, 3 months prior to separation, stated “the patient reports that his ankle continues to be unstable, and has pain with ambulation, and virtually any physical exercise.”  The physical examination recorded the absence of swelling, “pain reported by the patient in movement in all planes,” and “laxity when compared to the left ankle.”  

The 27 January 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, documented constant pain and functional impairment with “walking and reaching.”  The physical examination recorded a normal gait and absence of swelling or deformity without note of tenderness.  Measured ROM was PF to 45 degrees and DF to 10 degrees, specifying painful motion and non-quantified additional limitation with repetition due to pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing the “slight/constant” criterion of the US Army Physical Disability Agency pain policy.  The VA also rated the right ankle condition 10%, coded 5271 (limitation of motion), based on the C&P evidence and citing the applicable VASRD §4.71a criterion of “moderate” limitation.  Code 5271 offers a maximum rating of 20% for “marked” limitation.   

Panel members agreed that the higher rating under code 5271 was not supported by the ROM evidence, and that analogous rating for functional loss (via 5299-5283 or 5299-5262) could not be justified by objective evidence.  Given the absence of ankylosis or fracture with nonunion or malunion, there is no other applicable joint code which would yield a rating higher than the PEB’s 10%.  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.  The panel, therefore, recommends no modification or re-characterization of the CI’s disability and separation determination.  

AR20180016613, 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.