RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-05106 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090330

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Food Service Operator, medically separated for “right ankle pain” with a disability rating of 20%.

CI CONTENTION: Review requested of her eczema. 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 - 20081218	VARD - 20090728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5291	20%	Status Post Right Ankle Fracture with Open Reduction	5271	20%	20090518	
Eczema	Not Unfitting	Eczema	7806	0%	20090518	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Right Ankle Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured her right ankle after falling down stairs in August 2007, and she underwent a plate fixation of the distal fibula fracture with screw fixation of the medial malleolus and syndesmosis screw fixation across both right ankle bones. In April 2008, the hardware and syndesmosis screw were removed, but a broken screw fragment was retained in the anterior distal tibia. The CI was able to progress to full weight bearing, but pain and weakness continued. A nuclear medicine bone scan in July 2008 showed mild diffuse stress related periosteal reactions throughout both the right tibia and fibula.

The 22 October 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, noted tenderness during range of motion (ROM). The 14 November 2008 MEB NARSUM examination, documented CI complaints of constant right ankle pain and diffuse achiness along with numbness and tingling of the entire right foot. Physical examination (PE) showed dorsiflexion to 15 degrees (normal 20) and plantar flexion to 20 degrees (normal 45).

Achilles tendon tenderness and pain was noted at the proximal aspects of both the medial and lateral malleolus. Strength was 5/5 with all ROM, and sensation of the entire foot was decreased.

At the 18 May 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant right ankle pain traveling to the knee and thigh. Pain was elicited by physical activity and relieved by rest. The PE showed tenderness, but no signs of edema, effusion, weakness, redness, heat, guarding of movement, or subluxation. Posture and gait were normal, and dorsiflexion was to 20 degrees and plantar flexion to 12 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition 20%, coded “5291,” citing marked limitation of motion. The VA rated the right ankle condition 20%, coded 5271 (ankle, limited motion) based on the C&P examination, citing moderate/marked loss of ankle motion. Panel members noted a typographical error in the PEB’s coding for the right ankle condition, which should have been 5271; the PEB also assigned the maximum rating 20% available under this code. The panel agreed there was no evidence of ankylosis to warrant a higher rating under code 5270. 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.

Contended PEB Condition: Eczema. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not profiled or implicated in the commander’s statement, and did not 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, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the right ankle condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication. In the matter of the contended eczema, the panel agrees it cannot recommend it for additional disability rating. 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.

2	PD-2017-05106

XXXXXXXXXXXXXXXXXX. 

Dear: XXXXXXXXXXXXXXXXX

	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.