RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05342
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O2, Intelligence Officer, medically separated for “chronic 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 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 - 20060803	VARD - 20070117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5271	20%	Residuals of Right Ankle Fracture; Arthrofibrosis	5271	20%	20070324	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sprained her right ankle in May 2005 and was initially treated with an air cast and crutches, but pain and stiffness continued.  An MRI in August 2005 showed edema consistent with a non-displaced fracture of the talus with extension to the subtalar joint; and a possible partial deltoid ligament tear.  Despite restrictions and physical therapy, the right ankle pain did not completely resolve, and the CI was offered a surgical option in February 2006, which she declined because she was finally able to perform the majority of her daily activities without limitations.  However, she remained unable to run or walk for more than 20 minutes at a time.  

The 15 May 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of right ankle pain and stiffness.  The examiner noted no deformity, effusion or swelling.  When standing, the CI had normal alignment with 5 degrees of valgus which corrected with toe raising.  Range of motion (ROM) measurements showed dorsiflexion to 5 degrees (normal 20) and plantar flexion to 50 degrees (normal 45).  There was painful motion with passive dorsiflexion, and mild tenderness over medial malleolus, but no evidence of instability or decreased strength.  
At the 8 December 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported mild flare-ups of ankle pain lasting 1-2 days, and no use any assistive aids for walking.  Physical examination revealed dorsiflexion to 20 degrees and plantar flexion to 45 degrees.  There were no objective findings of pain, weakness, excess fatigability, incoordination, lack of endurance or loss in ROM with repetitive use.  An MRI showed no degenerative changes, and an X-ray revealed a subtalar effusion, but no evidence of a prior talus fracture.  There was no varus or valgus angulation in relationship to the tibia and fibula.  

During the 24 March 2007 C&P examination, 6 months after separation, the CI complained of right ankle pain, swelling, stiffness, and weakness, with giving way and instability.  Daily flare-ups could last from minutes to all day, and were usually precipitated by overuse and relieved with rest.  She could stand comfortably for 15-30 minutes without pain, and did not use any assistive devices for walking, but wore shoes with built up heels recommend by her foot and ankle specialists.  The examiner noted that she was able to walk into the room independently with a normal smooth gait.  After performing three heel rises, she reported increased pain, stiffness and weakness that additionally limited joint function.  Measured right ankle ROM, after repetition, showed dorsiflexion to 0 degrees and plantar flexion to 40 degrees.  The calcaneus was noted to be in physiologic valgus angulation in relation to the tibia and fibula.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 20%, coded 5271 (limited motion of ankle), citing dorsiflexion limited to 5 degrees.  The VA initially rated the right ankle condition 0%, coded 5271, citing non-compensable ROM, but upon appeal, the right ankle condition was increased to 20%, based on the March 2007 C&P examination, citing marked limitation of motion.  Panel members noted that the PEB assigned the maximum 20% rating available under code 5271, and agreed that the ROM examinations proximate to separation were consistent with the “marked” limitation of motion for this rating.  The panel considered other VASRD ankle and analogous codes but all were less applicable or not advantageous for rating.  The panel also deliberated over whether code 5284 (other foot injuries) offered a higher rating (§4.7), but adjudged that a “severe” level (30%) of impairment was not supported.  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.   

SAF/MRB

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05342.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.