RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-04858
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060516

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “pain and right ankle instability” with a disability rating of 10%.   

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 – 20060309	VARD – 20070119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain and Right Ankle Instability	5099-5003	10%	Right Ankle	5271	10%	20060815	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Ankle Pain and Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his right ankle in August 2000 during a previous period of active duty.  He underwent surgery in August 2003 for repair of the lateral ligament and left the service in December 2003.  He re-enlisted in September 2004, and by December 2004 was complaining of right ankle swelling and soreness, especially with running.  Ankle X-rays on 12 October 2005 showed irregularity of the medial aspect of the distal fibula and minimal soft tissue swelling over the lateral malleolus.  An MRI on 22 November 2005 showed a small joint effusion and a detached talar portion of the anterior talofibular ligament.

During the 3 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported constant pain and had to use an ankle brace during physical training and field exercises.  Physical examination revealed crepitus with rotation, positive anterior drawer, and tenderness at the anterior talofibular ligament.  Ankle range of motion (ROM) measurements performed by physical therapy on 20 January 2006, showed right ankle dorsiflexion of 14 degrees (normal 20) and plantar flexion of 52 degrees (normal 45), compared to left ankle dorsiflexion of 14 degrees and plantar flexion of 47 degrees, after repetition, and with no guarding or pain limitations.   The 3 February 2006 MEB NARSUM examination, 3 months before separation, noted CI complaints of substantial pain with running and ankle “locking.” Physical examination showed laxity of the lateral ligament with a definite endpoint and a positive anterior drawer sign on the right (compared to the left).

At the 15 August 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported an achy pain, rated at 3/10, which occurred 4 times a day and caused difficulties with walking long distances or on uneven surfaces, and prolonged standing.  Physical examination showed a normal gait and posture, and no edema, effusion, weakness, tenderness, redness, heat, abnormal or guarding movement.  Right ankle dorsiflexion was to 20 degrees and plantar flexion to 45 degrees, with end range pain but no additional limitation with repetition.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing degenerative arthritis with some loss of joint motion.  The VA also rated the right ankle condition 10%, but coded 5271 (ankle, limited motion of), based on the C&P examination, citing moderate limited motion of the ankle.  Panel members agreed that the right ankle limitation of motion recorded at the time of the MEB NARSUM examination was mild, however, there was pain with use and ligamentous laxity supporting a 10% rating for functional loss (§4.40 and 4.59).  The imitation of motion was not “marked,” therefore the next higher rating under 5271 was not justified.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable or not advantageous to rating.  After due deliberation, considering all 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.  

BOARD FINDINGS:  In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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.    

	PD-2017-04858

XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX

	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

	PD-2017-04858