RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04833
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “right ankle pain” with a disability rating of 20%. 

CI CONTENTION:  “Review all conditions.”  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 – 20050316	VARD - 20060518	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain 	5099-5003	20%	Status Post Right Ankle Fracture	5299-5271	10%	20050927	
Right Knee Pain	Not Unfitting	Patellofemoral Syndrome, Right Knee	5299-5024	10%	20050927	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained a fracture of the right fibula and underwent an open reduction internal fixation on 18 December 2003.  On 12 June 2004, the CI had the screws removed.  Post-surgical X-rays revealed changes in the distal fibula suggestive of previous fracture as well as calcifications in the interosseous membrane.  There was also lucent areas in the distal fibula and tibia likely from hardware treatment.  No other abnormalities were noted.  The 27 January 2005 orthopedic examination noted continued right ankle pain post ORIF with stable examination.

The 27 January 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued right ankle pain mostly over the anteromedial aspects of the ankle.  The pain was exacerbated with any attempts at running, jumping, marching, prolonged ambulation or prolonged standing.  Physical examination showed a mild antalgic gait favoring the right lower extremity.  There was no edema, erythema or ecchymosis.  There was mild tenderness over the anteromedial aspect of the ankle.  Active range of motion (ROM) was 0 degrees of dorsiflexion (normal 20) and 30 degrees of plantar flexion (normal 45).  Inversion and eversion had mild symptoms of pain.  

At the 27 September 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported constant pain and stiffness and had difficulty walking long distances.  Physical examination showed a normal gait with no deformity of the ankle.  ROM was dorsiflexion of 10 degrees and plantar flexion of 40 degrees, with pain in both planes of motion.  The examiner stated the joint function was additionally limited by pain on repetition, but was not additionally limited by fatigue, weakness, lack of endurance or incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the right ankle condition 10%, coded 5299-5271 (limited motion of the ankle) based on the C&P examination 4 months after separation, citing functional loss due to pain.  The panel noted that the PEB assigned the maximum rating (20%) available under diagnostic code 5271.  While analogous coding under 5262 (impairment of the tibia, fibula and ankle) was appropriate in this case, the ankle disability was not best characterized as “marked.”  Therefore, the next higher 30% rating was not justified under this code.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint codes which would yield a rating higher than the 20% rating adjudicated by the PEB.  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.  

Contended PEB Condition:  Right Knee Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right knee pain, the panel recommends no change from the PEB determination as not unfitting.  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 20170527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  
AR20180006733, 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