RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME:  XXXXXXXXXXXXXXXX                                                        BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200872                                                          SEPARATION DATE:  20011231 
BOARD DATE:  20130102 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SGT/E-5  (92Y2P/Supply  Specialist),  medically 
separated  for  pain  and  loss  of  motion  left  ankle.    The  CI  inverted  his  foot  forcibly  during 
airborne operations at Fort Greely, received splinting on the drop zone, and was Medevac’d to 
Bassett Army Hospital.  The CI was diagnosed with a fracture of the left fibula and disruption of 
the ankle joint and he underwent open reduction internal fixation (ORIF) surgery.  Despite left 
ankle immobilization, a second surgery to remove the compression screw, a third surgery for 
partial excision of a peroneal neuroma, pain medication and physical therapy (PT); the CI failed 
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  MEB  forwarded  status  post (s/p)  left  ankle  fracture,  ORIF  with  superficial 
peroneal nerve neuroma removal to the Physical Evaluation Board (PEB).  Occasional low back 
pain condition, identified in the rating chart below, was also identified and forwarded by the 
MEB.  The PEB adjudicated pain and loss of motion left ankle condition as unfitting rated 10% 
with probable application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The 
remaining  condition  was  determined  to  be  not  unfitting  and  therefore  not  ratable.    The  CI 
made no appeals, and he was medically separated with a 10% disability rating.   
______________________________________________________________________________ 
 
CI CONTENTION:  The CI elaborated no specific contention in his application.   
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The ratings 
for  unfitting  conditions  will  be  reviewed  in  all  cases.    Any  conditions  or  contention  not 
requested in this 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:   
 

 
ANALYSIS SUMMARY:  The Board’s authority as defined in DoDI 6040.44, resides in evaluating 
the  fairness  of  Disability  Evaluation  System  fitness  determinations  and  rating  decisions  for 

Service IPEB – Dated 20011012 
Condition 
Pain  and  Loss  Motion  Left 
Ankle after Fibular Fracture 

Code 
5099-
5010 

Rating 

10% 

Occasional Low Back Pain 

Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

VA (3 Mos. Post-Separation) – All Effective Date 20020101 
Condition 
Rating 
Degenerative  Joint  Disease,  Left  Ankle 
Associated  with  Fracture,  Left  Tibia  and 
Fibula 
Degenerative 
Degenerative Arthritis Lumbar Spine 
Right Hand Strain 
Left Hand Strain 
0% X 1 / Not Service-Connected x 1 
Combined:  40% (Bilateral Factor 1.9) 

Code 
5010-
5271 
5010-
5293 
5024 
5024 

Disease  with 

Disc 

20% 

10% 
10% 
10% 

Exam 

20020411 

20020411 
20020411 
20020411 
20020411 

disability at the time of separation.  The Board utilizes VA evidence proximal to separation in 
arriving  at  its  recommendations;  and,  DoDI  6040.44  defines  a  12-month  interval  for  special 
consideration to post-separation evidence.  Post-separation evidence is probative only to the 
extent  that  it  reasonably  reflects  the  disability  and  fitness  implications  at  the  time  of 
separation. 
 
Left  Ankle  Condition.    There  were  two  range-of-motion  (ROM)  evaluations  in  evidence,  with 
documentation of additional ratable criteria, which the Board weighed in arriving at its rating 
recommendation; as summarized in the chart below.                                   
 

Left Ankle ROM 

Dorsiflexion (0-20⁰) 
Plantar Flexion (0-45⁰) 
Inversion (35⁰)* 
Eversion (25⁰)* 

Comment 

MEB SF 88  
~5 Mo. Pre-Sep 
5°  
20°  
 
 
and 
Surgical 
scars 
x-ray: 
decreased  ROM; 
retained  hardware-fibular 
plate 
 
20% 
20% 

PT  
~3 Mo. Pre-Sep 
20⁰ (18) 
45⁰ (44) 
5⁰ 
0⁰ 
 
of 
Severe 
inversion/eversion 
 
 
20% 
10% 

loss 

VA C&P  
~4 Mo. Post-Sep 
5⁰ 
15⁰ 
 
 
Pain  on 
stable; 
medial/lateral  scars  on  distal  left  leg  well 
healed  not  bound  to  underlying  tissue  but 
painful in medial aspect to manipulation 
 
20% 
20% 

all  ROM 

stresses; 

§4.71a Rating 
5262 
5271 
* http://osteoarthritis.about.com/od/osteoarthritisdiagnosis/a/range_of_motion.htm 
 
The CI underwent an ORIF to repair the fracture of the left tibia with disruption of the ankle 
joint in March 2000.  Post-operatively, the CI wore a splint for immobilization for 2 weeks, a cast 
for  4  weeks  and  then  he  was  referred  for  PT.    He  had  a  failed  response  to  PT  as  the  pain 
continued and in May 2000, the CI underwent removal of the compression (syndemosis) screw.  
The CI did not show any pain reduction or progress in his rehabilitation and was subsequently 
also diagnosed with a peroneal neuroma.  He underwent a partial peroneal neuroma excision 
with  peroneal  nerve  superficial  branch  nerve  transposition  in  January  2001.    The  CI  again 
attempted PT but there was no resolution of his pain or limitation of movement.  Orthopedics 
determined that the CI would not benefit from further surgery and the CI was referred for MEB.  
The MEB exam recorded on the SF Form 88 and completed approximately 5 months prior to 
separation  noted  continued  pain  and  weakness  of  the  left  ankle.    It  included  ROM 
measurements that appear to have been measured downward from the vertical axis, instead of 
from  the  horizontal  axis  as  is  normally  done.    The  MEB  narrative  summary  (NARSUM) 
completely  approximately  4  months  prior  to  separation  did  not  include  any  specific  physical 
findings  but  referred  to  the  MEB  SF  Form  88  and  an  attached  a  formal  ROM  testing  report.  
However,  the  only  ROM  measurements  available  in  the  record  were  completed  by  physical 
therapy in October 2001 and these are recorded in the chart above.  The NARSUM indicated 
that the CI complained of constant aching in the left ankle, swelling and stiffening when he was 
on his feet too much, an inability to run, jump, or perform sit-ups; he could only tolerate limited 
walking with frequent breaks every 1-200 meters due to pain.  The examiner opined that the CI 
could not function in a specialty that required him to be on his feet a majority of the time nor 
was  there  an  expectation  that  his  condition  would  improve  with  further  therapy  or  surgery.  
The  service  treatment  record  also  contains  ROM  measurements  from  March  2001  with 
dorsiflexion of 15 degrees and plantar flexion of 50 degrees and more remotely from August 
2000  with  dorsiflexion  of  15  degrees  and  plantar  flexion  of  40  degrees.    The  left  ankle 
dorsiflexion appears to have been consistently and significantly limited over time.  The PT ROM 
from October 2001 appears to be different from all other measurements both before and after.  
The  VA  Compensation  &  Pension  (C&P)  examination  performed  4  months  after  separation 
noted chronic left ankle pain and a left ankle X-ray demonstrated post-traumatic degenerative 

   2                                                           PD1200872 
 

joint disease.  The C&P physical exam findings are summarized in the chart above.  The ROM 
measured by the C&P exam is more consistent with the more limited ROM recorded in the rest 
of the record than with the PT ROM from October 2001. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB coded the pain and loss of motion left ankle as analogous to 5010 arthritis, due to trauma, 
substantiated by X-ray findings and rated 10%.  The VA used a hyphenated code 5010 (Arthritis, 
due  to  trauma,  substantiated  by  X-ray  findings)  -  5271  (Ankle,  limited  motion  of).    The  VA 
determined  this  was  a  marked  limitation  of  motion  and  assigned  a  20%  rating.    The  Board 
considered that the CI’s primary disability was pain, loss of motion in the left ankle as evidenced 
by  PT  documentation  of  “severe  loss  of  inversion  (foot  turned  inward)  and  eversion  (foot 
turned outward).”  The NARSUM clearly documented constant pain, swelling, and stiffening of 
the left ankle, an inability to walk more than 1-200 meters without frequent breaks due to pain, 
and  intolerance  to  running,  jumping,  and  sit-ups  due  to  pain.    At  the  VA  exam  the  ROM’s 
showed more limited of the dorsiflexion and plantar flexion that was consistent with all of the 
CI’s recorded ROMs other than the measurements from PT in October 2001.  The examiner did 
not  measure  inversion  or  eversion.    The  Board  agreed  that  the  preponderance  of  evidence 
documented a moderate ankle disability overall.  VASRD 5262 tibia and fibula, impairment of 
with moderate ankle disability most accurately describes the CI’s disability picture.  After due 
deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (Resolution  of 
reasonable doubt), the Board recommends a disability rating of 20% for the left ankle disability 
after fibular fracture condition coded 5262.   
 
 
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 left ankle condition, the Board unanimously recommends 
a  disability  rating  of  20%,  coded  5262  IAW  VASRD  §4.71a.    There  were  no  other  conditions 
within the Board’s scope of review for consideration.   
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation:   
 

UNFITTING CONDITION 
Left Ankle Disability after Fibular Fracture 

 
 
 
 
 
 
 
 
 
 
 

VASRD CODE 
5262 
COMBINED 

RATING 
20%  
20% 

   3                                                           PD1200872 
 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120609, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

   4                                                           PD1200872 
 

 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXXXX, AR20130002540 (PD201200872) 
 
 
1.  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 to modify the individual’s disability rating to 20% 
without recharacterization of the individual’s separation.  This decision is final.   
 
2.  I direct that all the Department of the Army records of the individual concerned be 
corrected accordingly no later than 120 days from the date of this memorandum.    
 
3.  I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 
shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 
 
 BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
 
 
 

     XXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 
 
 

 
 
 

 
 
 

 
 
 

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