RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04201
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E8, Transportation Senior Sergeant and Health Care Specialist, medically separated for “chronic right ankle pain” with a disability rating of 10%.

CI CONTENTION:  In addition to the right ankle condition, the CI requested review of several additional conditions 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 - 20050316	VARD - 20050913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5271	10%	Status Post Right Ankle Achilles Tendon Repair	5271	20%	20050723	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Right Ankle.  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his right ankle in June 2004 while playing basketball and underwent Achilles tendon repair the next day. At a VA rehabilitation discharge assessment on 9 November 2004, the CI reported left ankle pain with stiffness.  Physical examination showed the CI was able to heel walk, but had difficulty toe walking on the right.  Range of motion (ROM) testing showed plantar flexion of 40 degrees (normal 45) and dorsiflexion of 10 degrees (normal 20); painful motion was not addressed.  

The 8 December 2004 MEB NARSUM examination, approximately 4 months prior to separation, noted complaints of chronic pain at the back of the right ankle limiting his ability to run.  Physical examination showed a “near normal” gait with a slight limp and difficulty pushing off his right foot.  There was right ankle swelling and tenderness.  Neurological examination was intact.  The ROM evaluation performed by physical therapy, showed plantar flexion of 30 degrees and dorsiflexion of 5 degrees; painful motion was not addressed.  

At the 23 July 2005 VA Compensation and Pension (C&P) general examination, approximately 4 months after separation, the CI reported progressively worse right ankle pain with stiffness and swelling in the right Achilles area.  Physical examination showed a limp secondary to his right Achilles tendon.  The Achilles repair was very nodular, edematous and tender.  The ROM study showed plantar flexion of 15 degrees and dorsiflexion of 10 degrees with pain.  

During the 12 October 2005 C&P joints examination, 7 months after separation, the CI reported continued right ankle stiffness, pain and decreased ROM.  He did not utilize an orthotic device and could only walk 100 yards on a typical day then had to stop due to increased pain.  Physical examination showed a slight limp favoring the right leg.  There was no right ankle instability and the Achilles tendon alignment was normal during weight bearing and non-weight bearing.  There was slight Achilles tendon thickening.  The ROM evaluation showed plantar flexion of 40 degrees and dorsiflexion was 10 degrees.  Painful motion was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (ankle, limited motion), citing “moderate” limitation of motion.  The VA rated the right ankle condition 20%, also coded 5271, based on the C&P general examination, citing “marked” limitation of motion.  

The panel considered if the ankle limitation of motion was “moderate” or “marked” when considered under 5271.  The panel noted that four ROM examinations from November 2004 through October 2005 demonstrated right ankle dorsiflexion of 5 to 10 degrees.  The panel majority considered these examinations to be congruous with “marked” limitation of motion required for the 20% rating under this code, as recorded by the MEB NARSUM and VA ROM examinations.  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 majority 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 majority recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  The single voter for dissent recommends no re-characterization but does not elect to submit a minority opinion.  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	
Chronic Right Ankle Pain 	5271	20%	

The following documentary evidence was considered:

AR20190004339, 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.