RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04460
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Automated Logistics Specialist, medically separated for “chronic pain, right ankle and foot” with a disability rating of 10%.   

CI CONTENTION:  No specific contention made.  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 - 20041118	VARD - 20050803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Ankle and Foot	5009-5003	10%	Residuals, Right Ankle Sprain	5271	10%	20050228	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Ankle and Foot.    According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured her right ankle in mid-2003 after jumping off a trailer and later reinjured it when she stepped in a hole.  Despite physical therapy (PT) and the use of orthotics, her symptoms remained.  X-rays of the right foot and ankle showed no fracture or arthritic changes.  A bone scan completed on 29 April 2004 indicated a small focal area of minimally increased uptake at the anterior portion of the right mid-foot in the region of the talonavicular joint.  

The 14 October 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain with prolonged standing or walking.  Physical examination (PE) revealed tenderness about the right ankle without instability.  Ankle range of motion (ROM) testing showed dorsiflexion of 0 degrees (normal 20) and normal plantar flexion (45 degrees).  Painful motion was present.  

At the 28 February 2005 VA Compensation and Pension (C&P) examination, 3 weeks after separation, the CI reported right ankle pain with prolonged standing.  Additionally, she endorsed painful flare-ups every 2-3 months with a duration of 1-2 days.  Ankle ROM testing revealed normal dorsiflexion (20 degrees) and plantar flexion of 35 degrees.  Painful motion was present.      

The panel directed attention to its rating recommendation based on the above evidence.  Panel members first clarified that although the PEB indicated this disability included the right ankle and foot, the foot and ankle were not considered separate unfitting conditions and thus this case was not a situation of condition bundling.  The STR clearly identified the inciting injury as being directly and solely involving the right ankle.  The PEB rated the right ankle condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing application of the US Army Physical Disability Agency pain policy.  The VA rated the right ankle condition 10%, coded 5271 (ankle, limited motion of; moderate), based on the C&P examination, citing painful and limited motion.  

There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of ankle motion (5271) on the VA examination which was closest to separation.  However there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45).   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 ankle condition.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, 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. 

The following documentary evidence was considered:

AR20180014214, 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.