RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04677
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Formal Training Instructor, medically separated for “left ankle fracture” with a disability rating of 20%.

CI CONTENTION:  Review requested of an additional condition 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 - 20050404	VARD - 20061120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Fracture	5271	20%	Status Post Left Ankle Fracture	5271	10%	20050927	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Ankle Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in April 2003 after he fell out of a tree and sustained a displaced left distal tibia fracture.  He underwent an external fixator placement to the left lower extremity followed by fasciotomies and several washouts.  One year later, he continued to have left ankle pain with high impact activity including running.  On 14 October 2004, he had a left ankle arthroscopy with debridement of cartilage and an open anterior osteophyte excision.  

At the 22 November 2004 physical therapy evaluation, 1 month after the final operation and 7 months prior to separation, left ankle range of motion showed decreased eversion and inversion, and normal dorsiflexion and plantar flexion without exact measurements reported.  At the 1 December 2004 MEB NARSUM addendum examination, 6 months before separation, the CI was back to full weight bearing with minimal pain during ambulation.  However, he still had pain with prolonged standing and increased activities.  No physical examination was performed.

At the 27 September 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported persistent left ankle pain with recurring swelling.  No ankle brace was used.  Physical examination showed a normal gait, and no left ankle swelling or deformity.  Dorsiflexion was 30 degrees (normal 20) and plantar flexion was 40 degrees (normal 45); no pain, weakness, fatigability, decreased endurance or incoordination was noted.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 20%, coded 5271 (ankle, limited motion).  The VA rated the left ankle condition 10%, also coded 5271, based on the C&P examination, citing “moderate” limitation of motion.  Members noted the PEB awarded the highest rating available using code 5271.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code to support a rating higher than the 20% adjudicated by the PEB.  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 left ankle condition.

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71, 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:

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Dear XXXXXXXXXX
Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04677.
After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.
I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.