RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXXXXXX                                                         BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1201227                                                        SEPARATION DATE:  20020628 
BOARD DATE:  20130215 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SPC/E-4  (91J/Medical  supply  specialist),  medically 
separated  for  decreased  range-of-motion  (ROM),  and  pain,  of  the  left  ankle,  w/pes  planus.  
While TDY for air assault training in December 2000, the CI was hit by a car in a crosswalk.  The 
CI was seen at the military clinic; however, he was unable to complete training and returned to 
his  home  unit.    He  sought  medical  attention  in  February  2001  and  imaging  revealed 
inflammation in both ankles, but no broken bones.  Bone scan was positive for inflammation 
bilaterally but not specific for this injury.  Initially he was diagnosed with left subtalar arthrosis, 
but  after  orthopedic  and  podiatric  treatment  (to  include  injections)  and  clarification  of  no 
arthritis, the diagnosis was changed to chronic left ankle and mid foot pain and instability due 
to trauma.  The CI could not be adequately rehabilitated to meet the physical requirements of 
his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a 
permanent L4 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded 
no other conditions for Physical Evaluation Board (PEB) adjudication.  The PEB adjudicated the 
left ankle as unfitting, rated 10%, with application of the Veteran’s Affairs Schedule for Rating 
Disabilities (VASRD).  The CI made no appeals, and was medically separated and released from 
active duty due to medical disability. 
 
 
CI CONTENTION:  “Left ankle problem which would not allow soldier to perform his physical 
duties, Post Traumatic Stress Disorder” 
 
 
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  ratings  for  unfitting  conditions  will  be 
reviewed in all cases.  The unfitting left ankle condition meets the criteria prescribed in DoDI 
6040.44  for  Board  purview  and  is  addressed  below.    Any  conditions  or  contention  not 
requested  in  this  application,  or  otherwise  outside  the  Board’s  defined  scope  of  review 
posttraumatic stress disorder (PTSD), remain eligible for future consideration by the respective 
Service Board for the Correction of Military Records. 
 
 
RATING COMPARISON:   
 

VA (2 Mos. Pre-Separation) – All Effective Date 20020629 

Service IPEB – Dated 20020315 
Code 
Condition 
5271 

Left ankle, decreased ROM, 
and pain, …  

Rating 
10% 

↓No Additional MEB/PEB Entries↓ 

Condition 

Left ankle, residuals of injury …  
Left index finger, residuals … 
Hypertension 

Code 
5271 

5299-5225 

7101 

Rating 
0%** 
0% 
0% 

Exam 

20020430 
20020430 
20020430 
20020430 

0% X 3 above / Not Service-Connected x 1 

Ankle ROM 

(Measured in Degrees) 

Dorsiflexion (0-20) 
Plantar Flexion (0-45) 

PT ~6 Mo. Pre-Sep 
Right 

Left 
-10* 
25 

2 
35 

Comment 

*“Lacks 10⁰ to 
0/Neutral DF” 

Left 
10 
25 

Right 
12 
35 

L ankle w/ mild generalized 

tenderness; Drawer sign (-); mild 
valgus-varus laxity; strength 3-4/5; 

Neurovascular intact; 1+ foot & 

ankle edema; TTP  

Left 
0-20 
0-45 

Right 
NE 
Normal gait; no painful 

motion, edema, instability or 
weakness; no flat feet; no 
limited function of standing 

or walking; has left foot 

insert 

0% 

NA 

Combined:  10% 

Combined:  0%* 

*Derived from VA Rating Decision (VARD) dated 20020629 (most proximate to date of separation (DOS)) 
** Rating increased to 10% based on VARD dated 20110928 effective 20101209 
ANALYSIS SUMMARY:   
 
Left  Ankle  Condition.    The  narrative  summary  (NARSUM)  noted  failure  of  non-surgical 
treatment to the left foot and ankle injury, with no surgery recommended.  The CI had constant 
baseline  pain  with  walking  causing  an  almost  immediate  increase  in  pain.    The  goniometric 
range-of-motion (ROM) evaluations in evidence for the left ankle which the Board weighed in 
arriving  at  its  rating  recommendation,  with  documentation  of  additional  ratable  criteria,  are 
summarized in the chart below.  The right ankle is included for comparison purposes only. 
 

MEB ~4 Mo. Pre-Sep 

VA C&P ~2 Mo. Pre-Sep 

§4.71a Rating 

20% 

NA 

10% 

NA 

 
The MEB physical exam noted mild generalized tenderness, greatest about the lateral joint line 
with  1+  ankle  and  foot  edema.    There  was  mild  valgus-varus  laxity  and  decreased  ankle 
strength.  Specialty exam of December 2001, 5 months prior to separation (and a month after 
the charted PT exam above), was referenced and indicated ankle tenderness with the “ankle 
joint noted to dorsiflex approximately 5⁰ past 90 with the knee flexed.”  The ankle/foot exams 
are summarized above.  The MEB examiner noted dorsiflexion of the left ankle is less than 10 
degrees  and  contributes  to  the  pain  when  he  tries  to  walk.    Improvement  is  highly  unlikely.  
(The  CI)  cannot  walk  or  stand  without  significant  pain.    He  is  unable  to  walk,  much  less  run 
without  significant  pain.”    Diagnosis  was  “chronic  left  ankle  pain,  instability,  and  decreased 
range of motion following injury.”  Bilateral X-rays and bilateral magnetic resonance imaging 
(MRI) exams performed in January 2002 were unremarkable (there was no evidence of arthritis 
at  the  ankle).    Weight  bearing  X-rays  on  7  September  2001  noted  mild  bilateral  pes  planus 
deformity, greater on the right than the left, otherwise unremarkable.  At the VA Compensation 
and Pension (C&P) exam, 2 months prior to separation, the CI reported constant left ankle and 
foot  pain  exacerbated  by  prolonged  walking,  prolonged  standing,  shifting  weight,  and  heavy 
lifting that is alleviated by rest.  He also reported episodes of intense left ankle pain that took 
several days to decrease to a manageable level.  Physical exam showed full ROM without pain.  
There was no weakness, lack of endurance, or incoordination impacting left ankle function.  X-
rays showed no abnormalities. 
 
The examiner indicated there were no signs of abnormal weight bearing on examination of the 
feet.    The  (CI)  had  a  shoe  insert  in  his  left  shoe  and  did  not  have  flatfeet.    There  was  no 
evidence  of  tenderness,  edema,  painful  motion,  edema,  instability,  or  weakness  bilaterally.  
Posture and gait were normal.  There was no limited function of standing or walking.  ROM was 
not affected by pain, weakness, lack of endurance or incoordination.  Left foot and ankle X-rays 
were read as normal.  Diagnosis was “left ankle and foot condition, no abnormal findings on 
today’s exam.”  The VA rated this exam at 0% as “The review failed to establish any significant 
occupational impairment from the claimant’s service-connected disabilities.” 

 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  and  VA  both  coded  the  condition  under  code  5271  (Ankle,  limited  motion),  based  on 
significantly  different  exams.    It  is  obvious  that  there  is  a  clear  disparity  between  these 
examinations, with very significant implications regarding the Board's rating recommendation.  
The Board discussed the interpretation of the PT exam being either complete ROM of plantar 
flexion 10-25 degrees as indicated above, or dorsiflexion 10 degrees of 20 degrees normal and 
plantar flexion of 0-25 degrees.  Since the exam was most distant from separation and there 
was a clear trend of improvement in the ankle exams summarized above the PT exam had little 
probative value for rating at the time of separation.  The Board thus deliberated the probative 
value  assignment  of  the  MEB  versus  the  VA  conflicting  evaluations,  but  neither  exam  would 
support  a  rating  higher  than  10%  (Moderate  limitation)  under  code  5272  or  any  alternative 
coding.  The record indicated some dorsiflexion was maintained and supported  the disability 
picture  as  best  represented  by  the  MEB  exam.    Additionally,  although  the  VA  exam 
demonstrated  likely  improvement,  the  Board  cannot  lower  the  combined  PEB  10%  disability 
determination.  After due deliberation, 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 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.    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 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: 
 

Decreased range of motion, and pain, of the left ankle 

UNFITTING CONDITION 

VASRD CODE  RATING 

5271 

COMBINED 

10% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120717, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXXXXX, DAF 
           Acting Director 
           Physical Disability Board of Review 

 

 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXXXX, AR20130003818 (PD201201227) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)