RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xx	CASE:  PD1300066
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20130604
Date of SEPARATION:  20030426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PO3/E-4 (EN3/Engineman) medically separated for a bilateral ankle condition.  He has a long history of bilateral ankle pain, and has had multiple surgeries on each ankle.  The bilateral ankle condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards.  He was placed on limited duty and underwent a Medical Evaluation Board (MEB).  The bilateral ankle condition was found medically unacceptable, and was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The PEB found the bilateral ankle condition unfitting, and rated each ankle 10% for a combined disability rating of 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  Three other conditions (listed in the rating comparison chart below) were adjudicated as Category III (not separately unfitting, and not contributing to the unfitting condition).  The CI made no appeals, and was medically separated.

CI’s CONTENTION:  The CI elaborated no specific contention in his application.

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 the unfitting bilateral ankle conditions are addressed below.  The Category III conditions:  obstructive sleep apnea, asthma, mediastinal and right hilar adenopathy were not contended, and therefore not within the DoDI 6040.44 defined purview of the Board.  These and other contentions remain eligible for future consideration by the Board for Correction of Naval Records.

IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Navy IPEB – dated 20030124	VA* – (1 mo. Pre -Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Failed Resection, Subtalar Coalition, Bilaterally S/P Bilaterally Subtalar Fusions	5272-5003	10%	Subtalar Fusion, Left Ankle	5271	10%**	20030307	
	5272-5003	10%	Subtalar Fusion, Right Ankle	5271	10%**	20030307	
Obstructive Sleep Apnea (OSA)	Category III	OSA	6847	50%	20030307	
Asthma	Category III	Asthma	6602	10%	20030307	
Mediastinal & Right Hilar Adenopathy	Category III	Mediastinal & Right Hilar Adenopathy	6820	NSC	20030307	
No Additional MEB/PEB Entries	Other x 4	20030307	
Combined:  20%	Combined:  70%	
* Derived from VA Rating Decision (VARD) 20030326 (most proximate to date of separation (DOS))
** VARD 20070323 raised left & right subtalar ankle fusion ratings to 20% each based on a C&P 20070214 retroeffective to the DOS

ANALYSIS SUMMARY:

Bilateral Ankle Condition.  The CI has a long history of bilateral ankle pain.  Initially he was treated with anti-inflammatories, subtalar injections, physical therapy, and other conservative measures.  In December 1999, he had bilateral ankle surgery at Portsmouth Naval Hospital in Virginia, but this failed to relieve his pain.  In September 2001, he underwent subtalar arthrodesis of the left ankle.  Nine months later, he had the same procedure performed on the right ankle.  Postoperatively, it was determined that he would not be able to fully perform his required military duties and an MEB was initiated.  His MEB physical examination (PE) was on 13 September 2002, 3 months after right ankle surgery.  On exam, there was limited ankle motion, mostly eversion and inversion.  The examiner stated that dorsiflexion was full.  Measurement of ankle range-of-motion (ROM) revealed 30 degrees plantar flexion, and 10 degrees dorsiflexion.  Neurovascular status was intact.  Motor testing was normal and there was no evidence of instability.  In March 2003, the CI had a VA Compensation and Pension exam.  On exam, both ankles seemed well aligned.  They were generally puffy and diffusely enlarged, but not hot.  Ankle ROM testing revealed about 10-20 degrees of flexion and extension bilaterally.  The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Ankle ROM	MEB ~ 7 mos. Pre-Sep
(20020913)	VA C&P ~ 1 mo. Pre-Sep
(20030307)	
	Left	Right	Left	Right	
Dorsiflexion (20⁰ is normal)	10⁰	10⁰	10-20⁰	10-20⁰	
Plantar Flexion (45⁰ is normal)	30⁰	30⁰	10-20⁰	10-20⁰	
Comment	“dorsiflexion is full”	 “walks fairly normally for his size”	

The Board carefully examined all evidentiary information available, and directs attention to its rating recommendation based on the above evidence.  The Navy PEB and the VA chose different coding options for the ankle condition.  The PEB used VASRD code 5272-5003 (ankylosis, with degenerative arthritis).  The VA coded the ankle condition as 5271 (ankle, limited motion of).  Based on the evidence in the treatment record, and IAW VASRD §4.71a, the Board determined that the CI’s bilateral ankle surgery had left his ankles in good weight-bearing position.  Furthermore, with regard to ankle ROM, he had 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 each ankle was warranted.  The Board tried to find a path to a rating higher than 10%, 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 unanimously recommends no change in the PEB adjudication for the bilateral 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 bilateral 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	
Failed Resection, Subtalar Coalition, Bilaterally S/P Bilateral Subtalar Fusions	5272-5003	10%	
	5272-5003	10%	
COMBINED (w/ BLF)	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130208, 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) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
          (b) CORB ltr dtd 5 Nov 13

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- former USMC
- former USN
- former USN
- former USN