RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX		CASE: PD-2017-04088 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050218

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

CI CONTENTION: Review requested of an additional condition (PTSD) 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 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 - 20041210	VARD - 20050713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain/Instability, Left Ankle	5099-5003	10%	Left Ankle Ligament Tear Status Post Synovectomy	5271	10%	20050608	
Left Neck Pain	Not Unfitting	Left Neck Condition…	5237	NSC	20050608	
Left Knee Pain	Not Unfitting	Left Knee Condition	5257	NSC	20050608	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	
	
ANALYSIS SUMMARY:

Left Ankle Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent left ankle arthroscopic surgery in June 2003 for synovitis, which was debrided. At the time of the orthopedic visit on 24 March 2004, 11 months prior to separation, she reported left lateral ankle pain. On examination, left ankle range of motion (ROM) showed dorsiflexion of 20 degrees (normal) and plantar flexion of 45 degrees (normal), with painful motion during dorsiflexion.  Strength was normal and there was no instability.

The 5 October 2004 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of left ankle instability and pain, rated at 4/10 during rest, and 8/10 with activity. Physical examination showed moderate left ankle swelling and 4+/5 aversion strength. Left ankle ROM revealed dorsiflexion of 10 degrees and plantar flexion of 40 degrees. The left lower extremity was tender over the anterior talar fibula ligament, with negative drawer and tilt tests.

At the physical therapy appointment on 5 November 2004, 3 months before separation, the CI reported left ankle pain, especially in the morning and with cold weather. On examination, left ankle dorsiflexion was to 8 degrees and plantar flexion to 37 degrees. There was slight tenderness on the anterior ankle in plantar flexion and strength was 4+/5.

At the 8 June 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI complained of left ankle swelling, difficulty with standing and walking, and not being able to run or jump without constant pain. She required a brace for ambulation and stated the condition did not result in any time lost from work. She described one incapacitating episode over the past year which lasted for 4 days. Physical examination revealed a normal gait, left ankle dorsiflexion of 20 degrees and plantar flexion of 45 degrees, and no joint function additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 10%, analogously coded 5003 (arthritis, degenerative), citing slight/constant pain. The VA also rated the left ankle condition 10%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing functional impairment during flare-ups. Panel members concurred that a 10% rating for functional loss due to instability and pain was appropriate, as adjudicated by both the PEB and VA. The panel considered whether the limitation of motion was “moderate” (10%) or “marked” (20%) under code 5271, and agreed that the ROM examinations proximate to separation were consistent with a 10% rating. 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.

2	PD-2017-04088

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE
385
ARLINGTON, VA 22202-3531

AR20200004492, 
Dear XXXXXXXXXXXXXX

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.