RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04327
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050412

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

CI CONTENTION:  Review requested review of the ankle condition as well as additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 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 - 20050105	VARD - 20050614	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Ankle Pain	5099-5003	0%	Residuals Modified Right Ankle Brostrom Procedure	5271	10%	20050317	
			Residuals Modified Left Ankle Brostrom Procedures	5271	10%	20050317	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bilateral Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a modified Brostrom procedure on the right ankle in March 2002 and on the left ankle in December 2002.  She continued to have pain and instability in both of ankles and had a third Brostrom procedure in March 2004 on the left.  Bilateral ankle X-rays showed pins/surgical changes in the lateral malleolus.  At the 29 October 2004 MEB physical therapy (PT) range of motion (ROM) evaluation on 29 October 2004, 5 months prior to separation, the CI reported bilateral ankle instability, right greater than left.  Following repetition, both right and left ankle ROM measurements showed dorsiflexion to 10 degrees (normal 20) and plantar flexion to 60 degrees (normal 45).  The 17 November 2004 MEB NARSUM examination noted CI complaints of chronic bilateral ankle pain with instability.  Physical examination showed a well-healed scar on both ankles with some palpable sutures on the right, and a positive anterior drawer on each ankle.  The examiner referred to the PT ROM measurements.  
At the 17 March 2005 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported bilateral ankle pain, and physical findings showed normal station and gait as well as well-healed surgical scars.  Dorsiflexion of both ankles was from 0-20 degrees, and plantar flexion from 0-40 degrees, without painful motion.  There was normal alignment of the os calcis with the longitudinal axis of the tibia-fibula, and no medial or lateral laxity, however, the examiner indicated the bilateral ankle condition caused “a moderate amount of physical impairment” and interfered with activities of daily living and “usual occupation.”  

The PEB rated the bilateral ankle condition 0%, analogously coded 5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated each ankle condition 10%, coded 5271 (ankle, limited motion of), based on the STR and C&P examination, citing moderate limited motion of each ankle.  Panel member noted that in this case, both ankles were profiled, implicated by the NARSUM and the commander’s statement, and failed retention standards.  There was no evidence which would permit the panel to discriminate the performance limitations attributable to either ankle over the other.  Since undue speculation would be required to conclude that impairment from either ankle would not have unacceptably interfered with the performance of military duties, panel members concluded that each ankle was reasonably justified as separately unfitting.  Accordingly a separate disability rating is recommended for each unfitting ankle.  The panel agreed that the ROM examinations proximate to separation were consistent with the “moderate” limitation of motion, but no higher, for a 10% rating for each ankle under code 5271.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a separately unfit determination with a disability rating of 10% for each ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the bilateral ankle condition, the panel recommends that each joint be separately adjudicated as follows:  an unfitting right ankle condition coded 5271 and rated 10%, and an unfitting left ankle condition, coded 5271 and rated 10%, both 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Ankle Pain Status Post Surgery	5271	10%	
Chronic Left Ankle Pain Status Post Surgery	5271	10%	
COMBINED	20%	

The following documentary evidence was considered:  

AR20200000668

Dear XXXXXXXXXXXXXX

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.