RECORD OF PROCEEDINGS 
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXX	BRANCH OF SERVICE: MARINE CORPS
CASE NUMBER:  PD0900517	BOARD DATE: 20100811
SEPARATION DATE:  20080929
_____________________________________________________________________________________

SUMMARY OF CASE:  This covered individual (CI) was a LCpl, Engineer Equipment Mechanic  medically separated from the Marine Corps in 2008 after two years and nine months of service.  The medical basis for the separation was Recalcitrant Ankle Pain Left. The CI was referred to the Physical Evaluation Board (PEB), found unfit for the condition determined unfit for continued military service and separated at 10% disability using the Veterans Affairs Schedule for Ratings Disabilities (VASRD) and applicable Naval and Department of Defense regulations.
_____________________________________________________________________________________

CI CONTENTION:  CI makes no contentions.
_____________________________________________________________________________________

RATING COMPARISON:

Service PEB	VA (4 Months after Separation)	
Unfitting Conditions	Code	Rating	Date	Condition	Code	Rating	Exam	Effective	
Recalcitrant Ankle Pain Left	5299-5003	10%	20080710	Left Ankle Injury, S/P Modified Brostrom’s Repair	5299-5273	10%	20090121	20080930	
		Not in DES	Tinnitus	6260	10%	20090121	20080930	
		Not in DES	Gastroesophageal Reflux Disease	7399-7346	0%	20090121	20080930	
		Not in DES	Bilateral Hearing Loss 	NSC				
TOTAL Combined:  10%	TOTAL Combined (Includes Non-PEB Conditions):    
20%  from 20080930 	
_____________________________________________________________________________________

ANALYSIS SUMMARY:

Ankle Pain
The CI had multiple left ankle injuries during boot camp and training and had continued left ankle pain despite conservative treatment and light duty.  After a course of physical therapy failed to alleviate his symptoms he was referred for surgery.  On 20080208 he had a left ankle stabilization procedure with peroneal subluxing repair.  He did have some decrease in his pain after the surgery but was not able to return to full duty. He continued to have pain and was not able to run or stand for prolonged periods of time.  On examination he had a normal gait and there was no evidence of joint instability.  There was no motor or sensory abnormality. However, he did have slightly decreased range of motion (ROM) and an X-ray done in January 2009 showed continued swelling.  ROM exams are noted in the chart below.  He also had lack of endurance and did sometimes have to sit down to rest his ankle while at work and he did not participate in any sports.  At the time of the VA Compensation and Pension (C&P) exam in January 2009 he was not having any difficulties with activities of daily living.

        (Separation Date 20080929, Surgery 20080208)
Movement
	Normal ROM
	ROM Military 20080417
Physical Therapy	ROM Mil
20080520
NARSUM	ROM VA
20090121
(4 Months after separation)	
Left Ankle	
Dorsiflexion	0 – 20	6	8	19	
Plantar flexion	0 - 45	48 (45)	Not documented	43	
Eversion 		18	2		
Inversion		20	15		
Notes:		Slight antalgic gait; normal sensation to light touch; motor not tested on left, 5/5 on right	There is no talar tilt or anterior drawer clunk or crepitus with range of motion; able to balance on left ankle; some tenderness to palpation	Normal gait; Motor 5/5 and symmetric; sensation intact; No instability compared to right; No evidence of excessive fatigability, weakened movement, incoordination, or further loss of motion.	
Right Ankle	
Dorsiflexion	0 – 20	20			
Plantar flexion	0 - 45	56 (45)			
Eversion 		22			
Inversion		32			

Other Conditions Not in the Disability Evaluatin System (DES)
Tinnitus, Gastroesophageal Reflux Disease, and Bilateral Hearing Loss
_____________________________________________________________________________________

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.  After careful consideration of all available information the Board unanimously determined that the CI’s condition is most appropriately rated as Recalcitrant Ankle Pain Left with a 10% disability rating.  The Navy PEB rated 10% under VASRD code 5299-5003 and the VA rated 10% under 5299-5273.  There is no specific code for this condition in the VASRD and either 5299-5273 or 5299-5271 could also be used to rate this condition.  However, the rating would be 10% with any of the codes and there is no advantage to the CI in choosing one code above the others.  Therefore no recharacterization is recommended.

The CI had multiple left ankle injuries which required surgical repair. He did show improvement after surgery but continued to have pain and lack of endurance after surgery and was not able to return to full duty.  He had slightly decreased ROM of his left ankle but this was below the minimum compensable level. VASRD §4.59 Painful motion states the intent of the schedule is to recognize actually painful, unstable, or malaligned joints due to healed injury, as entitled to at least the minimum compensable rating for that joint.  For the ankle the minimum compensable rating is 10%.
 
The other diagnoses rated by the VA (Tinnitus, Gastroesophageal Reflux Disease, and Bilateral Hearing Loss) were not mentioned in the Disability Evaluation System package and are therefore outside the scope of the Board.  The CI retains the right to request his service Board of Correction for Naval Records (BCNR) to consider adding these conditions as unfitting.
_____________________________________________________________________________________

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20090826, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.

                             

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL
                               OF REVIEW BOARDS 
Subj:   PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION
           ICO XXXXX
Ref:   (a) DoDI 6040.44
                   (b) PDBR ltr dtd 19 Aug 10
      I have reviewed the subject case pursuant to reference (a) and approve the recommendation of the Physical Disability Board of Review (reference (b)) that Mr. XXXX’s records not be corrected to reflect a change in either his characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board.