RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04282
BRANCH OF SERVICE:  army	SEPARATION DATE:  20080801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6 Correction Specialist, medically separated for “chronic right ankle pain” with a disability rating of 10%.  

CI CONTENTION:  “It has been an ongoing problem and it’s causing secondary issues which are also worsening.”  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 - 20080609	VARD - 20090212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	Right Foot Surgery Residuals	5299-5284	0%	20090925	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

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 September 2004 with a twisting type injury and there was a subsequent second injury 2 months later.  Orthopedics determined the CI had right ankle instability with a symptomatic os navicular and in August 2005 the CI underwent surgery (os navicular excised and posterior tibial tendon reattached).  Physical therapy and ankle injections provided only temporary relief.  Podiatry prescribed new orthotics (shoe inserts) along with additional steroid injection, which did not alleviate the ankle, first metatarsal, and lateral gutter pain.  Imaging revealed degenerative arthritis and chronic degenerative changes (enthesophytes/bone spurs) in the ankle.  
The 21 April 2008 MEB NARSUM addendum examination, 4 months prior to separation, noted complaints of right ankle pain and foot swelling with activity and the inability to run or perform a 2-mile ruck march.  Physical examination showed a slight decreased definition of the right arch on standing with slightly more pes planus on the right.  There was a neutral heel with toe raise.  Right ankle range of motion (ROM) was dorsiflexion of 20 degrees (normal) and plantar flexion of 47 degrees (normal 45), completed with goniometer and repetition.  There was mild crepitus in the tibiotalar joint and anterolateral aspect with circumduction of the right ankle.  

At the 3 June 2008 MEB NARSUM examination, 2 months prior to separation, the CI reported chronic right foot/ankle pain and swelling with activity.  Physical examination showed enthesophytes at the Achilles tendon and plantar fascia insertion sites, otherwise the remainder of the examination was normal and unchanged from the 21 April 2008 MEB addendum.  The diagnosis was “chronic ankle pain secondary to degenerative arthritis with sinus tarsus right subtalar joint and dorsal tenosynovitis vs. referred pain from the subtalar joint.”  

At the 25 September 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported pain in the right foot below the ankle which rose to a level of 5/10 and increased to the 7 to 10 level when being on the ankle all day.  Physical examination showed normal gait and posture.  There was no tenderness or pain with movement of the foot and toes.  There was increased prominence in the area of the first metatarsal proximal head and navicular on the right with slight swelling.  There was mild pes planus and a bone spur on the right heel.  There was normal sensory and motor function of the foot and toes with no additional limitation following repetitive use.  X-rays identified a small right heal spur and possible plantar fasciitis with dystrophic calcification.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right ankle condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing rated as analogous to degenerative arthritis of a major joint with some loss of ankle motion when compared to contralateral ankle.  The VA rated the right foot surgery residuals condition 0%, analogously coded 5299-5284 (foot injuries, other) based on the C&P examination, citing non-compensable evaluation was assigned as a bone spur on the right heal was revealed, and there was no indication of moderate symptoms associated with the foot injury.  

There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  However, all panel members agreed that the impairment did not more nearly approximate “moderately severe” to support the next higher 20% rating under this code.  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 chronic right ankle pain condition.  

BOARD FINDINGS:  In the matter of the chronic right ankle pain and IAW VASRD §4.71, 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.  
	PD-2017-04282

AR20190012179, XXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXX

	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-2017-04282