RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-03889
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090427

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Combat Engineer, medically separated for “left ankle pain” with a disability rating of 10%.

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 - 20090128	VARD - 20090818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain	5099-5003	10%	Left Ankle Deltoid Ligament Tear	5271	10%	20090714	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Left Ankle Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in February 2008 after a twisting injury. Left ankle X-rays in October 2008 showed a small calcaneal enthesophyte and an MRI showed a grade 2 osteochondral defect of the poteriolateral corner of the talus with bone marrow edema and cortical irregularity, as well as tears of the posterior deltoid and talofibular ligaments.

During the 10 December 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported left ankle pain while walking. Physical examination showed no tenderness, crepitus or edema, and provocative testing to elicit ligamentous instability was negative.   Range of motion (ROM) was decreased (not quantified).         The MEB

NARSUM examination on the same day noted complaints of ongoing left ankle pain exacerbated by prolonged standing, running or impact activities, and decreased ROM with flares. Baseline pain was rated at 0/10, but rose to 6/10 with flares. Left ankle ROM testing, after repetition, showed dorsiflexion of 10 degrees (normal 20) and plantar flexion of 40 degrees (normal 45).

At the 14 July 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported mild, constant left ankle pain with severe flares precipitated by running. However, he could walk or stand for 9 hours before he developed a significant increase in pain. Physical examination showed a normal gait, and left ankle ROM tests revealed painful dorsiflexion of 20 degrees and painful plantar flexion of 45 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing limitation of motion of one major joint. The VA also rated the left ankle condition 10%, but coded 5271 (ankle, limited motion of), based on the C&P examination, citing moderate limited ankle motion. Panel members agreed that the limitation of motion was no more than “moderate” based on the ROM examinations proximate to separation. A higher 20% rating was not indicated in the absence of “marked” limited ankle ROM. The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to 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 left ankle condition.

BOARD FINDINGS: In the matter of the left 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.

	PD-2017-03889

AR20190011855, XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX

	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-2017-03889