RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05440
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20070531

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

CI CONTENTION:  “The ankle and ligaments in the ankle were worse than decided upon at time of separation.  I had a surgery to repair ankle in 2016.”  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 - 20070502	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	No VA Exam Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA 	

ANALYSIS SUMMARY:  

Chronic Right Ankle Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right ankle condition began in September 2004 while deployed after twisting it on gravel while conducting physical training.  He was evacuated and placed in a cast.  Imaging revealed a small calcific density distal to the lateral malleolus, likely representing accessory ossicle versus avulsion fracture.  The ankle mortise was maintained while an impression of the lateral talus represented impaction injury with avulsion fracture distal to the lateral malleolus.  There was no acute fracture or dislocation identified.  There was a small spur at the dorsal distal talus and mild spurring at the Achilles attachment to the posterior superior calcaneus.  MRI studies in September 2005 showed evidence of previous lateral ankle trauma with evidence of prior injury to the anterior talofibular ligament.  He “severely” reinjured the right ankle again in January 2006.  Bone scan imaging of the right ankle in May 2006 revealed stress-related changes of the ankle as well as the midfoot.  MRI studies in August 2006 showed the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) were thickened, consistent with old and repetitive ankle inversion injuries.  There was no surrounding soft tissue edema and the deltoid ligament was intact.  The extrinsic tendons of the ankle were intact with no evidence of osteochondral defect.  

During the 2 April 2007 physical therapy (PT) range of motion (ROM) evaluation, right ankle dorsiflexion was measured at -5 degrees (normal 20), after repetition, and plantar flexion was measured at 40 degrees (normal 45).  Motion was limited by pain.  The 10 April 2007 MEB NARSUM examination, 1 month prior to separation, noted complaints of chronic right ankle pain.  Pain intensity was reported as 10/10 at its worse and 5/10 at best.  The pain lasted all day and was described as shooting to the lateral aspect of the leg with throbbing, burning and aching pain.  The condition was exacerbated by standing for more than 15 minutes, running, walking more than 300 meters, stairs and lifting more than 15 pounds.  Physical examination demonstrated a normal gait without tenderness, warmth or edema of the ankles.  Goniometric ROM measurements of the right ankle, following repetition, showed dorsiflexion of 0 degrees and plantar flexion of 55 degrees.  Evaluation by orthopedics concluded with a diagnosis of right ankle chronic inversion injuries involving the ATFL and CFL.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5099-5003 (degenerative, arthritis), citing moderate limitation of motion and pain.  Panel Members agreed that the ROM evidence was more reasonably characterized as “marked” limitation of motion consistent with the 20% rating under diagnostic code 5271.  The panel also considered whether the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7).  However, all panel members agreed that the right ankle impairment did not more nearly approximate “severe” to support a 30% rating under this code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right ankle condition, coded 5271.  

BOARD FINDINGS:  In the matter of the right ankle condition, the panel recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Ankle Sprain	5299-5271	20%	

	PD-2017-05440

XXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

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.

	PD-2017-05440