RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04764
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Human Resources Specialist, medically separated for “chronic left ankle and foot pain” with a disability rating of 0%.

CI CONTENTION:  No specific contention was 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 - 20051102	VARD - 20060629	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle and Foot Pain	5099-5003	0%	Left Ankle Sprain 	5271	10%	20051202	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Ankle and Foot Pain.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI underwent left ankle surgery in September 2003 for a talus osteochondral defect.  During an acute medical care visit on 24 June 2005 for foot pain, the physical examination revealed normal left foot range of motion (ROM).  At the 18 July 2005 MEB NARSUM addendum, 5 months prior to separation, the CI reported left ankle pain.  Physical examination revealed left ankle edema and tenderness.  Left ankle neurovascular testing was within normal limits and grossly intact.  Left ankle dorsiflexion was 7 degrees (normal 20), but plantar flexion and painful motion were not addressed.  
During the 26 September 2005 MEB NARSUM examination, 2 months prior to separation, the CI reported left ankle pain.  Physical examination noted a normal gait, but there was tenderness over the surgical scar.  Left ankle neurovascular testing was intact, but motor strength was 4/5 for inversion, eversion, plantar flexion and dorsiflexion.  Left ankle plantar flexion was approximately 20 degrees (normal 45), but dorsiflexion and painful motion were not addressed.

At the 2 December 2005 VA Compensation and Pension (C&P) examination, 3 days after separation, the CI reported daily left ankle pain which was limited by stiffness and aggravated by walking, running or sporting activities.  Physical examination showed a normal gait, and no left ankle crepitus, but tenderness was present.  Left ankle flexion (plantar flexion) was 5 degrees; dorsiflexion was not addressed.  Painful motion was elicited with flare ups.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle and foot condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing some loss of joint motion. The VA rated the left ankle and foot condition 10%, coded 5271 (ankle, limited motion), based on the C&P examination, citing moderate limitation of ankle motion.  

The panel first noted that despite the PEB’s inclusion of foot pain as part of the unfitting condition, the STR and VA did not provide any clinical evidence of the mid-foot or forefoot.  The panel considered if the ankle limitation was “moderate” or “marked” when considered under code 5271.  The panel agreed that the preponderance of STR evidence proximate to separation was consistent with the “moderate” limitation of motion to support a 10% rating under that code.  Although the PEB documented dorsiflexion restricted to 0 degrees, the panel did not find this measurement in evidence.  Additionally, the panel determined the VA ROM examination, which documented plantar flexion to 5 degrees, was an outlier.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable to rating.  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 and foot condition, coded 5271.

BOARD FINDINGS:  In the matter of the left ankle and foot condition, the panel recommends a disability rating of 10%, coded 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	
Chronic Left Ankle and Foot Pain	5271	10%	

The following documentary evidence was considered:

 [AR NUMBER], XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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. 

Sincerely,					      
Enclosure