RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxx	CASE:  PD-2017-05769
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Unit Supply Specialist, medically separated for “chronic right ankle pain” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20090204	VARD - 20091216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain 	5299-5262	10%	Right Ankle Fracture	5299-5271	10%	20091028	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Chronic Right Ankle Pain.  According to the MEB narrative summary (NARSUM), the CI fractured her right ankle in 2006 and underwent right ankle ORIF (open reduction internal fixation surgery) in March 2008, but post-operative right ankle pain did not improve.  During the 8 September 2008 MEB NARSUM, 6 months after surgery and 9 months before separation, the CI reported chronic right ankle pain.  Physical examination showed right ankle tenderness over the lateral malleolus.  The examiner noted “fairly good strength and good functional range of motion (ROM); painful motion was not addressed.   At the 7 January 2009 MEB ROM study by physical therapy, 10 months after surgery and 5 months before separation, the CI reported chronic daily right ankle pain.  Physical examination revealed dorsiflexion to 15 degrees (normal 20) and plantar flexion to 50 degrees (normal 45); painful motion was not addressed.  

At the 28 October 2009 VA Compensation and Pension (C&P) general examination, 5 months after separation, the CI reported constant right ankle pain with weakness, stiffness, swelling, instability, fatigability and lack of endurance.  She could not stand for prolonged periods or run.  She denied dislocation, recurrent subluxation and did not require crutches or brace for ambulation.  There were no incapacitating exacerbations.  Physical examination revealed normal gait, reflexes and motor strength.  Repetitive right ankle dorsiflexion was 20 degrees and plantar flexion was 45 degrees with pain, but there was no loss of motion with repetition.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5299-5262 (tibia and fibula, impairment), citing painful motion.  The VA also rated the right ankle condition 10%, analogously coded 5299-5271 (ankle, limitation of motion) based on the C&P general examination, citing “moderate” limitation of motion.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXX 

Dear XXXXXXXXXXX:

	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,					      

Enclosure