RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04719
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071025

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Translator Aide, medically separated for “posttraumatic arthritis and pain in the left ankle” with a disability rating of 0%.  

CI CONTENTION:  In addition to the left ankle condition, the CI requested review 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 - 20070907	VARD - 20080612	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthritis and Pain in Left Ankle	5010	0%	Left Ankle Sprain 	5010-5271	10%	20080507	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Posttraumatic Arthritis and Pain in the Left Ankle.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in October 2006 after a severe ankle sprain.  The CI declined surgical intervention.  An MRI in January 2007 documented an avulsion fracture at the talonavicular joint with bony spurring, and X-rays in May 2007 showed navicular bone abnormalities likely secondary to old avascular necrosis.  Final diagnosis leading to PEB referral was left foot traumatic osteoarthritis of the talonavicular joint (osteoarthritis with severe symptoms associated with impairment of function).  

During the 15 August 2007 MEB NARSUM podiatry examination, 2 months prior to separation, the CI complained of left ankle and foot pain.  Physical examination showed tenderness of the dorsal aspect of the rear left foot.  There was more pain with plantar flexion and inversion of the left foot.  There was a dorsal obvious bump when compared to the contralateral side at the level of the navicular (rear foot).  The 23 August 2007 physical therapy goniometric range of motion (ROM) study showed painful dorsiflexion of 0 degrees (normal 20) and plantar flexion of 45 degrees (normal), after repetition.  

At the 7 May 2008 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported moderate intermittent left foot pain 2-3 times a week with prolonged standing and walking for more than 8 hours.  He denied flare-ups, weakness, fatigability or use of assistive devices, but wore an orthotic insert in his left shoe.  Physical examination showed a normal gait and normal left foot evaluation.  The left ankle goniometric ROM study showed painful dorsiflexion of 10 degrees and plantar flexion of 35 degrees, after repetition.  ROM was not additionally limited by pain, fatigue, weakness or lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 0%, coded 5010 (arthritis, due to trauma, substantiated by X-ray findings), citing decreased ROM secondary to pain.  The VA rated the left ankle condition 10%, dual coded 5010-5271 (traumatic arthritis causing limitation of ankle motion), based on the C&P examination, citing moderate limited motion of the ankle.  

The panel next considered if the limitation of motion was “moderate” or “marked” when considered under code 5271.  The MEB ROM study recorded loss of dorsiflexion and normal plantar flexion, but did not address gait.  However, the subsequent C&P examination documented a normal gait with dorsiflexion to 10 degrees with near normal plantar flexion.  Panel members agreed the limitation supported a 10% rating for “moderate” limitation of motion, and did not more nearly approach the “marked” disability picture.  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  However, panel members agreed that the impairment did not more nearly approximate “moderately severe” to support a 20% rating under this code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left ankle condition, coded 5010-5271.  

BOARD FINDINGS:  In the matter of the left ankle condition, the panel recommends a disability rating of 10%, coded 5010-5271 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Posttraumatic Arthritis and Pain in the Left Ankle	5010-5271	10%	

The following documentary evidence was considered:

[AR NUMBER], XXXXXXXX

XXXXXXXXXX 
Dear XXXXXXXXXX:
The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability. I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation. This will not result in any change to your separation document or the amount of severance pay. A copy of this decision will be filed with your Physical Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Enclosure