RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXX	CASE:  PD-2021-00060
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Health Care Specialist, medically separated for “osteochondral lesion of right talus” with a disability rating of 0%.  

CI CONTENTION:  “Upon being discharged I found my ankle injury got worse and caused secondary medical conditions.  All of those conditions are in my VA records.  Before being discharged I sought help for my mental health conditions.  Upon release from my military service the VA diagnosed me with PTSD, Depression, and anxiety.”  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 - 20070810	VARD - 20080617	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteochondral Lesion of Right Talus	5099-5003	0%	Status Post Osteochondral Lesion Right Talus	5271	10%	20080606	
Post Operation Iraqi Freedom Deployment Stress Syndrome	Not Unfitting	PTSD and Secondary Major Depressive Disorder	9411	70%	20080527	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Osteochondral Lesion of Right Talus.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent right ankle surgery in August 2006 for removal of a loose talar fragment and drilling of the talar dome secondary to osteochondritis.  

During the 23 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported right ankle swelling when up for long periods or with increased activity.  Physical examination showed some ankle swelling and a slight decrease in range of motion (ROM).  The 27 April 2007 MEB NARSUM examination noted complaints of chronic right ankle pain aggravated by running, jumping or impact activities.  Physical examination findings showed normal reflexes and muscle strength.  The examiner referenced ROM measurements by physical therapy, which recorded “full right ankle active ROM, dorsal and plantar flexion” without providing an actual measurement.  Painful motion was not documented.  A right ankle MRI, without contrast, showed signal abnormality in the lateral talar dome and focal tendinosis in the peroneus longus tendon.  A right ankle weight-bearing series study was normal.  

At the 6 June 2008 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported using an ankle brace as needed, and pain rated at 5/10, with aching and throbbing.  Physical examination showed some lateral ankle tenderness, but no swelling.  Right ankle ROM was primarily limited by pain and showed dorsiflexion to 15 degrees (normal 20) and plantar flexion to 35 degrees (normal 45).  Repetition increased discomfort without further decreasing ROM.  There was also evidence of fatigue, weakness, and lack of endurance following repetitive motion.  The CI had a normal gait and was able to heel and toe walk without difficulty.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing no mechanical loss of motion, and pain which prevented running and bearing heavy loads.  The VA rated the right ankle condition 10%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing moderate limited ankle motion.  

Panel members agreed the C&P examination carried the greatest probative value for rating as it provided the most detailed ROM measurements.   Based on sufficient evidence of painful motion during ROM testing, the panel concluded that a rating of 10% was justified IAW VASRD §4.59 and §4.40, for painful motion and functional loss.  The panel also agreed that a 10% rating was achievable under code 5271 for moderate limitation of motion, but there was no rating advantage by changing the code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the ankle condition, coded 5099-5003.  

Contended PEB Condition:  Post Operation Iraqi Freedom Deployment Stress Syndrome.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  This condition was not profiled or implicated in the commander’s statement, and did not fail retention standards.  The April 2007 psychiatric consult noted the diagnosed condition was also known as anxiety disorder, not otherwise specified, and that it did not require a medical profile with any restrictions.  There were no other diagnosed mental health conditions found unfitting at the time of separation.  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, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended deployment stress syndrome, the panel agrees it cannot recommend it for additional disability rating.  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	
Osteochondral Lesion of Right Talus	5099-5003	10%	

Dear XXXXXXX:

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.