RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-04379
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050901

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Human Resource Specialist, medically separated for “chronic right ankle pain status post (S/P) talus fracture” 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 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 - 20050519	VARD - 20060306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain, S/P Talus Fracture	5099-
5003	0%	Right Ankle Talus Fracture, S/P Arthroscopy	5271	10%	20051028	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Right Ankle Pain S/P Talus Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began in 1999 when he broke the ankle playing in a soccer league game. Initial X-rays showed a lesion on the medial aspect of the talar dome. The CI underwent right ankle (dominant) arthroscopy with debridement and drilling of an osteochondral lesion of the medial aspect of the talar dome on 15 April 1999. A note dated 22 March 2005 indicated he complained of worsening pain and increased limitation in the range of motion (ROM).  X-rays of the right ankle dated 11 April 2005 were normal.

At the 28 April 2005 MEB NARSUM, 4 months prior to separation, the CI reported right ankle pain that had worsened since running more. He noted that even prolonged walking aggravated the ankle and on most days the pain was at a 3-4/10. Physical examination showed normal muscle strength at 5/5 in the upper and lower extremities. The right ankle ROM was 0 to -5 degrees dorsiflexion (normal 20) and 0 to 35 degrees plantar flexion (normal 45), with pain in all movements.          Right ankle inversion was 10 degrees (normal 35) and eversion was 5 degrees

(normal 15). There was some tenderness to the right malleolus, but no swelling, redness or warmth at the joint.

At the 28 October 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported right ankle pain. He was able to stand for 15-30 minutes and was able to walk more than a quarter mile but less than one mile. He reported some giving way and instability of the right ankle. There was pain, stiffness and weakness, but no reported subluxation or dislocation. He also reported flares that occurred once per week, which lasted 2 days, where he was unable to bear any weight. Physical examination showed a normal gait. The right ankle ROM was 10 degrees of dorsiflexion and 30 degrees of plantar flexion, both motions with pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition 0%, coded analogously 5099-5003 (degenerative arthritis), citing the U.S. Army Physical Disability Agency pain policy. The VA rated the right ankle condition 10%, coded 5271 (limitation of ankle motion), citing moderate limitation of motion.

The panel considered rating under the diagnostic code 5271, limited ankle motion and agreed that the ROM examinations at the NARSUM and VA proximate to separation were consistent with the “moderate” limitation of motion required for the 10% rating, and no higher, under that code. Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 10% rating adjudicated by the PEB. However, there was also evidence at both the NARSUM and VA examinations of painful motion causing functional loss to support the 10% rating (based on §§4.59, 4.40 and 4.45); however, this does not offer any additional benefit to the CI. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the chronic right ankle pain condition, coded 5271.

BOARD FINDINGS: In the matter of the chronic right ankle pain condition, the panel recommends a disability rating of 10%, coded 5271 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 S/P Talus Fracture	5271	10%	

The following documentary evidence was considered:

PD-2017-04379

AR20200000202, XXXXXXXXXXXXXXXXX 

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.

PD-2017-04379