RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04614
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20090316

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

CI CONTENTION:  The condition continues to worsen and negatively impacts his daily activities.  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 – 20081118	VARD - 20090423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5271	10%	Right Ankle Tenosynovitis	5024-5271	10%	20090319	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began in 2003 during a previous period of active duty.  His ankle pain improved significantly and he re-entered the service in January 2007.  Approximately 6 months later he began to have right ankle pain which progressively worsened.  The CI denied any injury or trauma.  An MRI study on 28 July 2008, revealed peroneus longus tenosynovitis.  

At the physical therapy (PT) clinic appointment on 10 July 2008, right ankle range of motion (ROM) testing showed dorsiflexion of 10 degrees (normal 20) and plantar flexion of 45 degrees (normal).  There was no pain with motion noted.  At the podiatry clinic appointment on 15 August 2008, ankle ROM was reported as full.  An antalgic gait was observed.  

The 21 August 2008 MEB NARSUM examination, 7 months prior to separation, noted complaints of chronic daily pain ranging from 3/10 to 8/10 with activity.  His pain worsened with crouching, crawling and going up and down stands to work on aircraft.  The examiner referenced the ROM examination performed by PT, but stated there was tenderness to palpation and pain with ROM in all planes.  Physical examination showed palpable grinding in the ankle with lateral abduction of the foot and tenderness along the lateral malleolus and dorsal foot and lower leg.  At the PT ROM examination of 20 October 2008, right ankle ROM following repetition showed dorsiflexion of 10 degrees and plantar flexion of 45 degrees.  Pain with motion was noted and gait was normal.  

At the 19 March 2009 VA Compensation and Pension (C&P) evaluation, 3 days after separation, the CI reported soreness over the top of his right foot that radiated up the tibia just lateral to midline.  The CI reported mild discomfort most of the time with flares three times a day to every other day.  The CI complained of sharp pain to both sides of his ankle.  Physical examination showed a mild antalgic gait.  There was tenderness over the peroneus longus tendon.  ROM of the right ankle showed dorsiflexion of 20 degrees and plantar flexion of 50 degrees with terminal pain.  There was no additional functional impairment with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (limited motion of the ankle), citing moderate limitation of dorsiflexion.  The VA also rated the right ankle condition 10%, coded 5024-5271, (tenosynovitis-limited motion of the ankle), based on the C&P examination 3 days after separation, citing moderate limited motion of the ankle.  

The panel considered if the limitation of motion was “moderate” (10%) or “marked” (20%) when considered under code 5271.  Panel members agreed the limitation of motion was no more than “moderate,” therefore supporting the 10% rating adjudicated by the PEB.  A higher rating of 20% was not indicated in the absence of “marked” limited ROM of the ankle.  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints, no malunion of the os calcis (calcaneus) or astragalus (talus), and no astragalectomy for consideration under the respective diagnostic codes of 5270, 5272, 5273 or 5274.  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 no modification or re-characterization of the CI’s disability and separation determination.   

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170512, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180006693 XXXXXXXXXXXXXXXXXX

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.

Sincerely,					      
Enclosure