[AR Number], XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
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.

Sincerely,					      

Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04854
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040303

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty, Cavalry Scout, medically separated for “chronic pain, left ankle,” with a disability rating of 10%.  

CI CONTENTION:  “Leg has gotten worse.”  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 - 20031112	VARD - 20040619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Ankle	5099-5003	10%	S/P Fracture of Left Fibula 	5299-5262	20%	20040601	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic pain, left ankle.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s ankle condition began in February 2003 after a motor vehicle accident.  He sustained a distal fibular fracture, which was plated with six screws.  The 25 June 2003 physical therapy (PT) evaluation, 8 months prior to separation, noted 0/10 pain.  The CI conducted phase one ankle rehabilitation at home; however, he did not follow-up in the recommended time frame.  On examination the CI walked with an antalgic gait (early heel rise in mid stance with short stance on the left).  The range of motion (ROM) study showed the CI reached “neutral in dorsiflexion” and plantar flexion was 35 degrees (normal 45).  The examiner recorded the CI was “status post ORIF, doing well.”  The prognosis reported was “Good for full return to duty in 10 weeks.”  

At the 11 August 2003 PT evaluation, 7 months prior to separation, the CI reported there no improvement in pain.  He was compliant with clinic and home exercise.  Physical examination revealed a wound on the dorsal medial surface of the foot, which was closed with 3 stitches, warm to touch, red and notably swollen.  The ROM study showed 0 degrees of dorsiflexion (normal 20) and 45 degrees of plantar flexion.  The 22 September 2003 MEB PT ROM examination, 5 months prior to separation, showed dorsi-flexion of 0 degrees and plantar flexion of 20 degrees.  

During the 29 September 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic left ankle pain.  Physical examination revealed surgical and compound fracture scars and limited dorsiflexion due to pain.  The MEB NARSUM examination, the same day, noted complaints of left ankle pain.  Physical examination showed no joint swelling.  There was no motor or sensory abnormality in the lower extremities.  The ROM evaluation showed dorsiflexion of 0 degrees and plantar flexion of 20 degrees.  

At the 1 June 2004 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported chronic pain and reduced motion of the left ankle.  Physical examination showed normal gait, stance and coordination.  There was mild crepitus, mild swelling and pain particularly on the joint line medial and lateral.  There was no other obvious deformity.  Motor strength was normal.  The ROM evaluation showed dorsiflexion of 20 degrees and plantar flexion of 20 degrees.  X-rays from July 2004 showed the fracture was well-healed without evidence of residual fracture line.  The ankle mortise was intact.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, analogously coded 5003 (arthritis, degenerative), citing slight and constant pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the ankle condition 20%, analogously coded 5262 (tibia and fibular, impairment of), based on the C&P examination, citing mal-union of the tibia and fibula with moderate ankle disability.  The panel agreed there was no evidence of mal-union as noted by the July 2004 X-rays.  The panel considered potential alternate coding and rating under code 5271 (ankle, limited motion of).  The panel majority agreed there was sufficient support for a 20% (marked) disability rating based upon significant decrease in dorsiflexion as reported by the June 2003, August 2003 and September 2003 PT examinations.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 20% for the left ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the left ankle condition, the panel majority recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  The single voter for dissent recommends no change but does not elect to submit a minority opinion.  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 Pain, Left Ankle	5271	20%