RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03993
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050929

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

CI CONTENTION:  The CI requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050906	VARD - 20051025	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5271	10%	Right Ankle Sprain	5299-5271	10%	20050928	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sprained her right ankle in 2002 and complained of constant right leg pain with a painful “knot” that ballooned out whenever she ran, jumped or stood for long periods of time.  She underwent a surgical compartment release on 27 February 2004 for fascial herniation.  Post-operative complications included a secondary infection of the surgical site which progressed to hypersensitivity about the surgical scar and decreased sensation on the right lower extremity.  
  
At the 11 August 2005 MEB NARSUM examination, 1 month prior to separation, the CI’s chief complaint was “right leg pain.”  Symptoms worsened with activities such as running, marching or standing greater than 15 minutes.  The CI additionally endorsed the inability to wear a combat boot.  Her physical examination (PE) revealed exquisite tenderness to light touch about the surgical incision on the front and side aspect of the lower right leg and decreased sensation on the back side of the same.  Right ankle range of motion (ROM) was decreased at 10 degrees of dorsiflexion (normal 20) and plantar flexion of 30 degrees (normal 45).  The right ankle and foot had decreased overall strength as compared to the left. 

At the 28 September 2005 VA Compensation and Pension (C&P) examination, 1 day before separation, the CI reported a history of recurrent ankle sprains.  Her PE revealed a right-sided antalgic gait.  Tenderness was present over the outside aspect and just above the right ankle.  Additionally, there was “some anesthesia distal to the incision.”  Right ankle ROM was documented as 5 degrees plantar flexion and 35 degrees dorsiflexion (extension).  Muscle strength was normal in both lower extremities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (limited motion of the ankle), citing moderate limitation of motion.  The VA also rated the right ankle condition 10%, analogously coded 5299-5271, based on the C&P examination, citing evidence of functional loss due to pain which affects the performance of normal working movements of the right ankle, a major joint.  Although the panel agreed that the VA examination held the greatest of probative value due to its proximity to separation (1 day), it noted the VA provider, more likely than not, erroneously interchanged the ROM naming directions based upon the documented measurements.  Members concluded that the documented 5 degrees of plantar flexion was really that of dorsiflexion and the documented 35 degrees of dorsiflexion was really that of plantar flexion.   

The panel considered if the limitation of motion was either “moderate” at 10% or “marked” at 20% when considered under 5271, limitation of ankle motion.  In utilizing the panels above conclusion with regards to the directional naming of ankle ROMs, the members further concluded that a 75% drop in ankle dorsiflexion (5 degrees out of normal 20 degrees) would clearly be above moderate impairment and was more representative of marked limitation.  After due deliberation, considering all 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 recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  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 Ankle Pain	5271	20%	

AR20180015899, 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.