RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04446
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090523

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

CI CONTENTION:  His PTSD and right ankle condition were rated at 40% by the VA.  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 - 20090213	VARD - 20090618	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	 Right Ankle Ligament Rupture	5099-5019 	0% 	20090424  	
Adjustment Disorder	Not Unfitting	 PTSD	9411	30% 	20090414 	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right ankle arthroscopy with Brostrom repair on 18 April 2008.  The 25 August 2008 MEB NARSUM examination, 8 months prior to separation, noted complaints of 2/10 right ankle pain which increased with running, jumping or prolonged walking or standing.  The CI indicated that he was unable to run, ruck march, jump, wear IBA or stand on his right foot.  Physical examination (PE) revealed a slight limping gait favoring the right ankle.  Right ankle motion was painful and decreased due to motor weakness (4+/5) in all planes of motion.  Range of motion (ROM) measurements were not provided.  “There was some instability of the right ankle noted with tenderness observed on ambulation.”  Reflexes were normal.  Electrodiagnostic studies in September 2008 were normal.  The 24 November 2008 physical therapy (PT) ROM study revealed right ankle dorsiflexion of 15 degrees (normal 20) and plantar flexion of 30 degrees (normal 45) with pain.  

At the 24 April 2009 VA Compensation and Pension (C&P) joint examination, 1 month prior to separation, the CI reported constant 4/10 right ankle pain elicited by activity with weakness and stiffness, but no swelling, heat, redness, give way, lack of endurance, locking, fatigability or dislocation.  He was unable to stand for long periods.  His PE revealed a normal gait without abnormal weight bearing, breakdown, callosities or unusual shoe wear pattern.  Bilateral ankle ROM was normal and there were no signs of local edema, effusion, weakness, tenderness, redness, heat, subluxation, deformity or guarding of movement.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing painful limitation of motion of one major joint.  The VA rated the right ankle condition 0%, analogously coded 5099-5019 (bursitis), based on the C&P examination, citing no objective evidence of painful or limited motion. 

Although the MEB PT ROM examination supports a 10% rating for limited motion under VASRD code 5271 or an alternative 10% rating based on painful motion (VASRD §4.59), the VA examination 1 month prior to separation showed no evidence of painful or limited motion.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  The panel concluded there was no rating higher than the 10% adjudicated by the PEB under any applicable 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 right ankle condition.  

Contended PEB Condition:  Adjustment Disorder.  Adjustment disorder was a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability ratings are recommended. 

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right knee condition and adjustment disorder, the panel agrees it cannot recommend it for additional disability rating.  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.  

The following documentary evidence was considered:

AR20190007294, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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.