RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXX			BRANCH OF SERVICE:  marine corps 
CASE NUMBER:  PD0900706			SEPARATION DATE:  20050930
BOARD DATE:  20110713			

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCpl/E-3 (0313, Armored Vehicle Crewman) medically separated for persistent left ankle pain.  The CI fractured his left ankle in August 2004 while he was changing a tire.  He was treated, but did not respond adequately to perform his required military duties or meet physical fitness standards.  He underwent a Medical Evaluation Board (MEB).  Left ankle fracture was addressed in the narrative summary (NARSUM) and forwarded to the Physical Evaluation Board (PEB) on the NAVMED 6100/1.  The PEB found the left ankle condition unfitting, and rated it 0%.  The CI accepted the PEB findings, and was medically separated with a 0% disability rating.  

CI CONTENTION:  “Ankle injury is still affecting my job and or get employed.  Also many other conditions have been found that are service connected.”  In block 14 of DD Form 294 the CI lists his VA rated conditions, so a contention for their inclusion in the separation rating is therefore implied. 

RATING COMPARISON:

Navy  PEB – dated 20050711	VA (3 mo. Post Separation) – effective date 20051001 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Left Ankle Fracture	5099-5003	0%	Closed Fracture, Left Fibula 	5262	20%	20051213	

↓No Additional MEB Entries↓	Bilateral Tinnitus	6260	10%	20051213	
	Irritable Bowel Syndrome (IBS)	7319	10%	20051213	
	Cystic Acne 	7806	10%	20051213	
	Bilateral Hearing Loss	6100	NSC	20051213	
 Combined: 0%	Combined: 40% 	

ANALYSIS SUMMARY:  

Left Ankle Condition.  This Marine was changing a tire on 18 August 2004.  The tire struck him in the knee, causing two fractures of the left ankle.  Ten days later, he underwent open reduction and internal fixation (ORIF) of the ankle fractures.  His postoperative course was unremarkable, and he achieved radiographic healing.  However, he continued to have pain in the left ankle (primarily medial) which precluded him from doing any running or high-impact activities.  He could tolerate elliptical running for about 15 minutes.  Any more than that would result in left ankle pain.  Examination of his left ankle on 27 June 2005 revealed some tenderness to palpation (TTP) and mild soft tissue swelling.  X-rays again showed good healing of the bony ankle injury.  In December 2005 (two-and-a-half months after separation) the CI underwent a VA compensation and pension (C&P) exam at the Minneapolis VA Medical Center.  The examiner documented left ankle TTP, and pain with motion.  Two goniometric range of motion (ROM) evaluations were in evidence which the Board used in arriving at its rating recommendation.  Left ankle ROM from both exams is summarized in the following table.  
Left Ankle	Separation Date: 20050930	
Goniometric ROM	MEB exam – 20050627 
(3 mos. Pre-Separation)	VA C&P exam – 20051213 
(2½ mos. Post-Separation)	
Dorsiflexion  (20⁰ is normal)	10⁰ 	(unable to perform)	
Plantar Flexion  (45⁰ is normal)	40⁰ 	45⁰ (pain at 45⁰)	
§4.71a Rating	0%	10%	
Comments	No mention of painful motion	10% based on limited motion	

The PEB and VA chose different coding options for the left ankle condition.  The PEB coded the ankle 5099-5003 (analogous to degenerative arthritis), while the VA used diagnostic code 5262 (impairment of tibia/fibula, with malunion or nonunion).  The Board carefully reviewed all evidentiary information available.  The Board determined that since the CI had some limitation of ankle motion; the most appropriate code would be 5271 (limited ankle motion).  Normal ankle motion involves 65 degrees of joint excursion, from full dorsiflexion to full plantar flexion.  At his VA C&P exam, the CI had 45 degrees of left ankle excursion.  After due deliberation, the Board unanimously recommends a disability rating of 10% for the chronic left ankle condition.  It is appropriately coded 5271 and meets criteria for the 10% (moderate) rating level, IAW VASRD §4.71a.  

Remaining Conditions.  Acne, gastrointestinal (GI) disease, and several other conditions were also found in the Disability Evaluation System (DES) file.  None of them were implicated in the commander’s statement.  They were all reviewed by the action officer and considered by the Board.  It was determined that none could be argued as unfitting and subject to separation rating.  Tinnitus and posttraumatic stress disorder were rated by the VA, but were not found in the DES file.  The Board does not have the authority to render fitness or rating recommendations for any conditions not considered by the DES.  The Board therefore has no reasonable basis for recommending any additional unfitting conditions for separation rating.

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 left ankle condition (IAW VASRD §4.71a) the Board unanimously recommends a disability rating of 10%.  In the matter of the acne, GI disease, or any other conditions eligible for consideration, the Board unanimously agrees that it cannot recommend any findings of unfit for additional rating at separation. 

RECOMMENDATION:  The Board therefore recommends modification of the CI’s disability and separation determination as detailed below.

UNFITTING CONDITION	VASRD CODE	RATING	
Left Ankle Pain, With Limitation Of Ankle Motion (Moderate)	5271	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20091130, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.

                             		

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION
          	ICO XXXXX, FORMER USMC, XXX XX XXXX

Ref:   (a) DoDI 6040.44
          (b) PDBR ltr dtd 1 Aug 11

1.  I have reviewed the subject case pursuant to reference (a) and approve the recommendation of the Physical Disability Board of Review (reference (b)).

2.  The subject member’s official records are to be corrected to reflect the following disposition:

	a. Separation from the Naval service due to physical disability rated at 10 percent (increased from 0 percent) effective 1 October 2005.

3.  Please ensure all necessary actions are taken to implement this decision and the subject member is notified once those actions are completed.