RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD1201718
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20130627
Date of SEPARATION:  20031128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SrA/E-4 (3E/Pavement & Construction Equipment) medically separated for a right ankle condition.  In May 2002, he injured the lateral collateral ligaments of his right ankle.  He underwent reconstructive surgery, but he did not adequately improve to fully perform his military duties or meet physical fitness standards.  He was issued a profile and underwent a Medical Evaluation Board (MEB).  The right ankle condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The PEB found the right ankle condition unfitting, and rated it 10%, IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated.

CI CONTENTION:  “I feel that I am 80% disabled now and I hurt just as much as when I discharged plus they A-96 my job and had to leave my base too soon.”

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 right ankle condition is addressed below.  No other conditions are within the defined purview of the Board. Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Air Force PEB – dated 20030915	VA – (1.5 mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5272	10%	Right Ankle, Residuals of Surgery	5271	10%	20040114	
No Additional MEB/PEB Entries	Other x 2	20040114	
Rating:  10%	Rating:  10%	
     Derived from VA Rating Decision (VARD) dated 20040607 (most proximate to date of separation)  

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed by the CI regarding the impairment with which his ankle condition continues to burden him, and the significant impact it has had on his quality of life.  It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the Disability Evaluation System (DES) operates.  The DES has neither the role nor the authority to compensate members for future severity or potential complications of conditions.  That role and authority is granted to the Department of Veterans Affairs (DVA).  The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation.  The DVA, however, is empowered to periodically re-evaluate conditions for the purpose of adjusting the CI’s disability rating should the degree of impairment change over time.
Right Ankle Pain.  The CI injured his right ankle in May 2002.  He underwent surgery to reconstruct the lateral collateral ligaments of the right ankle.  He also received steroid injections and physical therapy.  However, in spite of treatment, the ankle problem persisted and a MEB was initiated.  On 22 July 2003, physical examination of the right ankle revealed slight swelling.  There was pain with inversion but otherwise, range-of-motion (ROM) was preserved.  A month later, the CI’s ankle was examined by podiatry.  There was some tenderness, but no significant edema or effusion present.  Plantar flexion was diminished, and gait was antalgic.  As noted above, the CI was medically separated from in November 2003, due to the right ankle problem.  Six weeks after separation, the CI had a VA Compensation and Pension exam.  This exam was considered most probative.  There was slight tenderness of the right ankle, but no swelling or disability.  ROM was from 10 degrees to 45 degrees.  The examiner’s assessment was “residuals of surgery with decreased range of motion.”  The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Right Ankle ROM	Podiatry ~ 3 mos. Pre-Sep
(20030820)	C&P ~ 1½ mos. Post-Sep
(20040114)	
Dorsiflexion (20⁰ is normal)	(Not listed)	10⁰	
Plantar Flexion (45⁰ is normal)	“Diminished”	45⁰	
Comments	Some tenderness, but no significant edema	Slightly tender, no swelling, no disability	
§4.71a Rating	10%	10%	

The Board carefully reviewed all evidentiary information available and directs attention to its rating recommendation based on the above evidence.  The PEB and the VA chose different coding options for the right ankle condition, but both assigned a rating of 10%.  The PEB used VASRD code 5272 (ankylosis of subastragalar or tarsal joint).  The VA chose diagnostic code 5271 (limited motion of ankle).  The Board determined that the most appropriate code for the CI’s right ankle condition was 5271, since there was some limitation of ROM.  Based on the evidence in the treatment record, and IAW VASRD §4.71a, the Board determined that the CI’s ankle surgery had left his right ankle in good weight-bearing position.  With regard to ankle ROM, he had slight-to-moderate limitation of motion.  The record did not show sufficient evidence to characterize his limited ankle motion as “marked.”

After due deliberation, the Board determined that a separation disability rating of 10% for the right ankle was warranted.  The Board tried to find a path to a higher rating, using other codes which could be applied to the ankle condition.  The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a disabling ankle abnormality which would justify a rating higher than 10%.  Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right ankle condition, and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.

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 right ankle pain, status post ankle surgery 	5272	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120726, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2012-01718.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings