RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-05548
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070907

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

CI CONTENTION:  “Injury was more severe.”  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 - 20080620	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5271	10%	Residuals of Fracture, Left Ankle…	5271	20%	20080513	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained a fractured left ankle in July 2005 and subsequently underwent surgical fixation with the implementation of hardware, which was removed in February 2006.  Despite interval surgeries and extensive rehabilitation, the pain continued.  The 23 March 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of left ankle pain.  The physical examination (PE) revealed tenderness over the left ankle but no evidence of joint laxity or instability.  Range of motion (ROM) measurements, taken 5 months before separation, showed dorsiflexion to 5 degrees (normal 20) and plantar flexion to 28 degrees (normal 45).     

At the 13 May 2008 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported progressively worse left ankle pain with flare-ups every 2-3 weeks, during which time he opined that ROM was decreased by “about 90%.”  The PE revealed left ankle dorsiflexion to 5 degrees and plantar flexion to 10 degrees.  The examiner noted that pain was present prior to ROM, increased during ROM and did not decrease to baseline upon completion of ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5271 (ankle, limited motion of), citing slight antalgic gait, ankle tenderness and intact strength bilaterally with left ankle ROM 60% of the right ankle.  Utilizing the same VASRD code, the VA rated the ankle condition 20%, based on the C&P examination, citing marked left ankle limitation of motion with severe pain on testing.  Panel members deliberated over whether the limitation of ankle motion was best characterized as “moderate” or “marked” under code 5271, and concluded that a 75% drop in ankle dorsiflexion (5 degrees out of normal 20 degrees) would clearly be above moderate impairment and was more representative of a marked limitation.  After due deliberation, considering all of 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 left 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 the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Ankle Pain	5271	20%	

	PD-2017-05548

XXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

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. 

	PD-2017-05548