RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201124
BRANCH OF SERVICE:  Army	BOARD DATE:  20130507
SEPARATION DATE:  20021130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (11B/Infantry) medically separated for chronic left ankle pain.  In January 2002, the CI fractured his left ankle while in the U.S. Army Airborne School.  He underwent open reduction and internal fixation (ORIF) of the left ankle fracture.  However, his ankle condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The chronic left ankle condition, characterized as “chronic ankle pain secondary to a left ankle fracture status post orif,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The PEB adjudicated “chronic left ankle pain with a history of a fracture, with open reduction and fixation” as unfitting, rated 20%. The CI made no appeals, and was medically separated with a 20% disability rating.

CI CONTENTION:  “At the time of discharge, I believe there was marked limitation in motion on my ankle.  Thus, my rating should have been higher to reflect that marked limitation.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting chronic left ankle condition is addressed below.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in his application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – dated 20020925	VA - (< 1 mo. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5271	20%	Residuals of Left Ankle Fracture	5271	10%	20021107	
No Additional MEB/PEB Entries	Other x 1	20021107	
Combined:  20%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20030114 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  

Left Ankle Condition.  The CI fractured his left ankle during jump school. He underwent ORIF, with placement of plates and screws.  In spite of surgery and physical therapy, he continued to have left ankle pain and an MEB was initiated.  The MEB narrative summary is dated 12 September 2002.  The examiner noted a well-healed scar, with some swelling present.  Range-of-motion (ROM) testing revealed 30 degrees of plantar flexion and 5 degrees of dorsiflexion.  On 7 November 2002, the CI had a VA Compensation and Pension (C&P) exam.  Gait and station were normal.  There was no swelling or deformity of the left ankle.  ROM was measured and is shown in the chart below.  The examiner stated, “very slight decrease range-of-motion.  It does not appear to give him any tenderness, does not appear to give him any physical impairment at this point in time.”  The two ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Left Ankle ROM	MEB ~ 2½ mos. Pre-Sep
(20020912)	VA C&P ~ 1 mo. Pre-Sep
(20021107)	
Dorsiflexion (20⁰ is normal)	5⁰	10⁰	
Plantar Flexion (45⁰ is normal)	30⁰	30⁰	

The Board carefully examined all evidentiary information available, and directs attention to its rating recommendation based on the above evidence.  Both the Army PEB and the VA coded the ankle condition as 5271, but chose different rating options.  Based on the evidence in the service treatment record (STR), the Board determined that IAW VASRD §4.71a, the diagnostic code which most closely aligns with limited ankle motion is 5271 (ankle, limited motion of).  Under code 5271, the rating levels are: 10% for “moderate,” and 20% for “marked.”  The PEB rated the left ankle condition at 20%, for marked impairment of ankle motion.  The Board tried to find a path to a rating higher than 20%, using other codes which could be applied to the left ankle condition.  The other VASRD codes that were considered did not result in a higher rating, since his gait was normal, and the STR did not show sufficient evidence of a disabling ankle abnormality which would justify a rating higher than 20%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends no change in the PEB adjudication for the left ankle condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the chronic left ankle pain, and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic left ankle pain, with a history of fracture and ORIF	5271	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130010250 (PD201201124)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA