RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxx	CASE:  PD-2017-04784
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Basic Airman, medically separated for “distal tibial fracture” with a disability rating of 10%.  

CI CONTENTION:  Her ankle has worsened.  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 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 – 20070103	VARD – 20070403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rt Ankle Distal Tibial Fracture	5262	10%	Residual Rt Ankle Malleolar Fracture	5299-5271	10%	20070313	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Ankle Distal Tibial Fracture.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained a non-displaced fracture of the right posterior distal tibia extending into the tibiotalar joint on 12 October 2006 after a fall.  She was placed in a splint and hard cast.  

At the time of the orthopedics consult on 18 October 2006, 3 months prior to separation, physical examination showed significant swelling and ecchymosis on the medial aspect just inferior to the lateral malleolus of the right ankle.  There was decreased range of motion (ROM) secondary to pain with flexion and dorsiflexion and the CI was not able to tolerate eversion or inversion.  Strength was 4/5 (slightly decreased) but noted to be limited mostly due to pain and not a neurological deficit.  The CI was placed in a non-weight bearing cast.  The 26 October 2006 MEB NARSUM deferred to the 18 October 2006 orthopedic consult.  

At the 13 March 2007 VA Compensation and Pension (C&P) examination, 2 months after separation and 5 months after injury, the CI reported constant right ankle pain, throbbing in nature which was aggravated by walking, standing or exertion.  The pain was primarily on the posterior aspect, but also on the anterior and lateral aspects of the ankle.  Flare-ups of pain were noted as 8/10 and not relieved by medications. Use of a brace helped slightly.  Physical examination revealed tenderness on the posterior and anterolateral aspects of the right ankle.  The ankle was slightly swollen and gait was antalgic.  Right ankle ROM showed dorsiflexion of 10 degrees (normal 20) and plantar flexion of 20 degrees (normal 45) with painful motion.  Repetitive exercise reduced plantar flexion to 10 degrees due to pain and lack of endurance.  X-rays showed an old fracture of the distal tibia and slight irregularity of the medial aspect of the distal tibia.  The examiner stated the CI was severely impaired by constant pain and an inability to stand more than 10 minutes at a time or to carry moderately heavy objects.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle tibia fracture 10%, coded 5262 (tibia and fibula, impairment), citing Department of Defense and Veterans Administration Schedule for Rating Disabilities guidelines.  The VA also rated the right ankle condition 10%, analogously coded 5299-5271 (ankle, limited motion) based on the C&P examination, citing moderate limited motion of the ankle.  The panel considered if a higher rating under code 5262 (20% rating for “moderate” or 30% rating for “marked” ankle disability), and/or if the limitation of ankle motion was “marked” (20%) under code 5271.  Given the presence of an abnormal gait, swelling, use of a brace, flares, and plantar flexion of 10 degrees following repetition, panel members agreed that a 20% rating for “moderate” ankle disability under code 5262 was adequately supported.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right ankle condition, coded 5262.  

BOARD FINDINGS:  In the matter of the right ankle distal tibia fracture, the panel recommends a disability rating of 20%, coded 5262 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	
Right Ankle Distal Tibial Fracture 	5262	20%	

The following documentary evidence was considered:

 

Dear xxxxxxx:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04784.

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 not in accordance with the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept the recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.