RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04241
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070910

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Combat Engineer, medically separated for “osteoarthritis left ankle” with a disability rating of 0%.  

CI CONTENTION:  “Left ankle arthritis.”  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 - 20070809	VARD - 20080408	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis Left Ankle	5003	0%	Left Ankle Degenerative Arthritis	5003-5271	10%	20071206	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Osteoarthritis Left Ankle.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left ankle surgery in October 2006 at which time the ankle was debrided and osteophytes were removed.  Since then the CI has tried physical therapy, intra-articular injections and profiling without any improvement in his pain.  At the 19 March 2007 orthopedic outpatient clinic, approximately 6 months prior to separation, the CI reported pain over his left lateral ankle.  Physical examination showed a non-antalgic gait.  Drawer test was negative.  Range of motion (ROM) was good, with pain at the extremes of dorsiflexion.  There was tenderness over the lateral ankle, specifically over the course of the anterior talofibular ligament.  Sensory and vascular examinations were intact.  Surgical sites were well healed.  X-rays on 25 May 2007, 3 months prior to separation showed joint space narrowing and osteophyte formation along the posterior subtalar joint.  There was spurring of the mid calcaneus in a superior direction immediately posterior to the talus.  A 1 mm bone chip was identified in this region as well as soft tissue swelling.  

During the physical therapy clinic appointment on 31 May 2007, 3 months prior to separation, the CI reported left ankle pain.  On examination, ROM showed dorsiflexion of 2 degrees (normal 20) and plantar flexion of 40 degrees (normal 45) after repetitive motion.  A goniometer was used for all measurements and painful motion was noted.  The 2 July 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of constant 5/10 left ankle pain.  Physical examination showed a normal bilateral appearance with well healed incisions of the left ankle.  There was tenderness along the anterolateral aspect of the left ankle.  Laxity tests were negative.  ROM studies reported dorsiflexion of 4 degrees and plantar flexion of 40 degrees.  There was no weakness of the ankles.      

At the 6 December 2007 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported constant left ankle pain.  Physical examination showed a normal gait and stance.  Mild tenderness of the left ankle over the lateral malleolus was present.  There was no swelling and no redness.  Muscle strength was normal.  ROM of the left ankle showed dorsiflexion of 20 degrees and plantar flexion of 45 degrees after repetitive motion with terminal pain.  There was no additional functional impairment due to pain.  X-rays showed mild degenerative change.   
  
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, coded 5003 (arthritis, degenerative), citing osteoarthritis without limitation of joint motion.  The VA rated the left ankle condition 10%, dual coded 5003-5271 (degenerative arthritis-limited motion of ankle), based on the C&P examination, citing terminal pain during ROM testing and X-rays showing degenerative changes on the subtalar articulation. 

The panel noted that a 10% rating under code 5003 was the highest achievable rating for a single major joint.  The panel considered potential alternate coding and rating under code 5271; however, there was insufficient support for a rating higher than 10% under this code.  A coding change would not benefit the CI.  The panel determined the totality of evidence supports a 10% rating for the right ankle condition and no higher.  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 left ankle condition, coded 5003.

BOARD FINDINGS:  In the matter of the left ankle condition, the panel recommends a disability rating of 10%, coded 5003 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Osteoarthritis left ankle	5003	10%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170524, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180006264  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. 

Sincerely,					      
Enclosure