RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05219
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Police, medically separated for “right ankle pain” with a disability rating of 10%.  

CI CONTENTION:  Review requested of lower back pain, and post-traumatic stress disorder (PTSD), an additional condition not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20091022	VARD - 20100525	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	Residuals, Right Ankle Sprain	5299-5271	0%	20091209	
Low Back Pain	Not Unfitting	Lumbosacral Strain	5237	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s ankle condition began in May 2007, after falling on his right ankle with an inversion injury.  Initial X-rays were unremarkable.  The CI had persistence of pain, weakness and fatigability despite injections, anti-inflammatory and neuromodulator medication.  Following reports of episodic ankle/foot numbness, electrodiagnostic testing was performed and reported as normal.  Orthopedic and neurology evaluations indicated diagnoses of ankle joint stiffness, peripheral nerve injury of the peroneal nerve, and monoparesis of the right lower extremity.  An MRI done in January 2009 revealed a small amount of fluid in the retrocalcaneal bursa and was otherwise unremarkable.  X-rays on 9 February 2009, 10 months prior to separation, were normal.  

The 23 June 2009 orthopedic MEB NARSUM examination, 6 months prior to separation, noted complaints of right ankle pain that felt achy, and was exacerbated with prolonged standing, driving and running.  Physical examination revealed right ankle strength was reduced in dorsiflexion with normal strength in all other motor group functions and there was no muscle atrophy.  Sensation was intact.  Heel walking and toe walking were abnormal due to right ankle pain.  Right ankle range of motion (ROM) was dorsiflexion of 20 degrees (normal) and plantar flexion of 45 degrees (normal).  There was guarding with dorsiflexion and mild tenderness of the retrocalcaneal/Achilles insertion.  

At the 9 December 2009 VA Compensation and Pension (C&P) examination, 6 days before separation, the CI reported right ankle pain.  Physical examination revealed a wobbling gait.  Right ankle ROM was dorsiflexion of 40 degrees and plantar flexion to 35 degrees without any pain or tenderness.  There was no neurologic deficit reported.  The diagnosis was ankle sprain due to lacerated ligaments of the right ankle, by history.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the ankle condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing VASRD §§4.10; 4.40; 4.45; and, 4.59; to include consideration of functional loss due to factors such as pain, including pain on repeated use and painful motion; fatigability; incoordination; weakness with repetitive use; and flare-ups.  The VA rated the ankle condition 0%, analogously coded 5299-5271 (ankle, limited motion), based on the C&P examination, citing evidence did not show painful motion, limitation of motion as a result of pain, a moderate limitation of motion of the ankle, ankylosis (complete immobilization) of the subastragalar or tarsal joint in a good weight-bearing position, or a malunion of the os calcis or astragalus with a moderate deformity.  

All panel members agreed the right ankle limitation of motion, and/or painful motion was no more than “slight,” and therefore a higher rating of 20% was not indicated under code 5271 in the absence of “moderate” limited ROM of the ankle.  The panel next considered whether a higher rating was supported under other diagnostic code options.  Given the diagnoses of peripheral nerve injury peroneal nerve, and monoparesis of right lower extremity the panel considered alternative rating under neurological conditions; however, there was insufficient evidence for any rating higher than 10% (mild) under any VASRD §4.124a coding.  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:  Low Back Pain.  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 §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended back condition, 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.  

ARXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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,