RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04215
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20061208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Health Care Specialist, medically separated for “chronic right ankle pain” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  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 - 20061012	VARD -NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	0%	No VA Examination Proximate to Separation in Evidence	
Major Depressive Disorder	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began in November 2005 after conducting physical training.  At the time of the physical therapy (PT) clinic appointment on 10 April 2006, 8 months prior to separation, the CI reported 3/10 pain that increased with prolonged walking on uneven ground and inclines.  On examination, her gait was non-antalgic, but the right distal medial tibia showed tenderness.  There was no edema noted.  Range of motion (ROM) measurements were reported as normal.    

At the 17 April 2006 orthopedic evaluation, the CI reported persistent right ankle pain.  Physical examination showed pain with plantar flexion and dorsiflexion.  An MRI performed on 19 April 2006 showed multifocal patchy bone marrow edema in the distal medial tibia.  The radiologist indicated it was a slight vertical fracture, which was probably in a state of healing.  There was slight edema and swelling.  There were no other bony abnormalities in the ankle and the ligaments and tendons appeared normal.  

The 26 April 2006 MEB NARSUM examination, 8 months prior to separation, noted complaints of right ankle pain that limited her ability to perform physical training activities.  Physical examination showed right ankle tenderness with no swelling.  Plantar flexion and dorsiflexion strength were both normal (5/5).  Heel to toe raise was normal and she had a slightly antalgic gait favoring her right leg.  On examination, right ankle ROM showed dorsiflexion of 15 degrees (normal 20) and plantar flexion of 30 degrees (normal 45).  Painful motion was not addressed.

At the time of the PT clinic appointment on 8 May 2006, 7 months prior to separation, the CI reported 4/10 pain and weakness.  The examiner noted she had been in a cam walker for 6 weeks.  On examination, the right ankle ROM following repetition showed dorsiflexion of -8 degrees and plantar flexion of 15 degrees.  Painful motion was not addressed.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  Although the PEB rated the right ankle condition 0%, analogously coded 5003 (degenerative arthritis), citing application of the U.S. Army Physical Disability Agency pain policy, the panel agreed that the ROM examinations proximate to separation were consistent with the “moderate” limitation of motion required for the 10% rating under code 5271.  The panel also noted that there was an antalgic gait, painful motion and pain with use that met the criteria for a disability rating of 10% (based on VASRD §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right ankle condition coded 5271.  

Contended PEB Condition:  Major Depressive Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 10%, coded 5271 IAW VASRD §4.71a.  In the matter of the contended major depressive disorder, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Ankle Pain	5271	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170523, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180006260 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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure