RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04584
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “chronic right ankle pain” with a disability rating of 20%.

CI CONTENTION:  In addition to the right ankle condition, the CI requested review of several other conditions not identified by the Medical Evaluation Board (MEB) and 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’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 - 20090724	VARD - 20100326	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	20%	Right Ankle Surgical Residuals	5271	20%	20091110	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Right Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right ankle surgery with talofibular ligament repair and scar tissue debridement on 1 October 2008, 13 months before separation.   A post-operative MRI showed normal right ankle alignment, but “moderate” chondromalacia (damaged cartilage).

The 15 July 2009 MEB NARSUM examination, 4 months prior to separation, documented constant right ankle pain.  Functional limitations included climbing, prolonged standing and heavy load bearing.  Physical examination revealed an antalgic gait and right ankle tenderness without impingement or instability.  Dorsiflexion was 20 degrees (normal) and plantar flexion was 40 degrees (normal 45); painful motion was elicited, but there was no additional limitation with repetition.

At the 10 November 2009 VA Compensation and Pension (C&P) examination, 8 days after separation, the CI reported worsening pain with weekly flares of moderate severity that prohibited standing longer than 15 minutes or walking more than a quarter-mile.  The CI used a cane and ankle brace.  Physical examination recorded a right foot limp with outward deviation, right ankle effusion, tenderness and instability (positive drawer test).  Dorsiflexion was 10 degrees and plantar flexion was 30 degrees; painful motion was present.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, analogously coded 5099-5003 (arthritis, degenerative), citing 10% for painful motion of a major joint, and 10% for disturbance of function of a major joint IAW VASRD §4.10, 4.40, 4.45, and 4.59.  The VA also rated the right ankle condition 20%, coded 5271 (ankle, limited motion), based on the C&P examination, citing “marked” limitation of motion.

The panel considered whether a higher rating was supported under other VASRD §4.71a code options.  Given the absence of ankylosis (stiffness of a joint due to abnormal adhesion and rigidity) or fracture with nonunion or malunion, there is no other applicable joint code which would yield a rating higher than the PEB’s 20%.  The panel considered a rating under code 5284 (foot injuries, other) that requires “severe” disability to render a 30% rating, but panel members agreed that the evidence of record most approximated a “moderately severe” disability (20%) at the time of separation, which provides no rating advantage to the CI.  The panel also agreed that rating under code 5262 (tibia and fibula, impairment) did not support a 30% rating for “marked” right tibia-fibula disability.  After due deliberation, considering all of 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.

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 there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

[AR Number], XXXXXXXXXX

Dear XXXXXXXXXX:

	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.