RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04212
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070111

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Bradley Fighting Vehicle System Maintainer, medically separated for “chronic bilateral ankle pain” with a disability rating of 0%.

CI CONTENTION: Both ankles continue to worsen and negatively impact daily activities of life. The CI also requested review of 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 - 20061122	VARD - 20070504	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Chronic Bilateral Ankle Pain	5099-
5003	
0%	Left Ankle Degenerative Joint Disease (DJD)	5010	0%	20060912	
			Right Ankle DJD Status Post Ligament Repair with Residual Asymptomatic Scar	5010	0%	20060912	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Chronic Bilateral Ankle Pain. The PEB combined both ankle conditions under a single disability rating, coded analogously to 5003 and rated 0% with application of the US Army Physical Disability Agency pain policy and AR 635-40 B24.f. This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.       The panel noted that “bundling,” the combining of two or

more major joints, may be permissible under the VASRD 5003 rating requirements, and that this approach does not compromise the VASRD §4.7 directive to choose the higher of two valid ratings. The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings. When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.

According to the service treatment record and MEB NARSUM, the CI’s bilateral ankle condition began in 2000 after injury during physical training. Eventually, the CI underwent left ankle surgery in November 2005 for delayed primary ligament repair. There was no surgical indication for the right ankle. Radiograph imaging of the right ankle from September 2005 showed mild widening of the lateral joint mortise and posterior joint.

During the 28 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported he had left ankle surgery, and needed surgery again and that he also needed surgery on the right ankle. The examiner noted bilateral ankle pain. The examination did not record specific range of motion (ROM) measurements although the examiner noted there was decreased strength and dorsiflexion of the left ankle. There was nothing mentioned about the right ankle. The 15 August 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of pain in both ankles, but pain was worse on the left side. Physical examination showed no edema, erythema, increased warmth, induration, nodules, exostosis, or deformity of either ankle. Both ankles were tender. For the right ankle, there was no limitation of ROM and ROM was normal and equal actively (no specific active ROMs were recorded). There was no tenderness elicited on motion. Both ankles were noted to have swelling/stiffness.

At the 12 September 2006 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported constant localized pain which was aching in nature. At the time of pain he could function without medication. The condition did not cause incapacitation. Physical examination showed a normal gait; both ankles revealed no signs of deformity, edema, effusion, weakness, tenderness, redness, heat, abnormal movement, or guarding. Dorsiflexion was 20 degrees (normal) and plantar flexion was 45 degrees (normal) bilaterally. There was no reported objective evidence of painful joint motion, nor further limitation of motion or function with repetitive use.

The panel first considered if the ankle conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above. In this case, both ankles were considered to fail retention standards. They were implicated in the commander’s statement as interfering with duty performance, both were deemed medically unacceptable, with the caveat that the left was worse than the right ankle, and both were profiled. Therefore, panel members agreed, each ankle was separately unfitting and recommended separate rating for each ankle. The panel then, based on the above evidence, considered its rating recommendation for the unfitting bilateral ankle condition at the time of separation. The PEB rated the bilateral ankle condition 0%, analogously coded as 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy. The VA rated the right ankle condition 0% and the left ankle condition 0%, each coded 5010 (traumatic arthritis), based on the C&P examination, citing no evidence of painful or limited joint motion of the ankle for either ankle.

There was no limitation of motion of the ankle joint to support a rating under diagnostic code 5271 (limitation of motion) and the MEB, NARSUM and C&P examinations did not note the

presence of painful joint motion. The panel members agreed that the C&P examination offered greater probative value since it was the most comprehensive examination closest to separation. The C&P examination showed full ROM of both ankles and absence of both swelling and f painful motion. The gait was normal and there was no evidence of functional loss that would impact functioning in the average civil occupation. 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 bilateral ankle condition.

BOARD FINDINGS: In the matter of the bilateral 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.

The following documentary evidence was considered:

PD-2017-04212

AR20190012192, XXXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX

	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-2017-04212