RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01438
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141216
SEPARATION DATE:  20040717

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Aircraft Ordnance Technician), medically separated for talus bone and related ankle problems.  These conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a series of limited duties and eventually referred for a Medical Evaluation Board (MEB).  The talus and ankle conditions, characterized as “traumatic osteochondral lesion of the talus” and “sinus tarsi syndrome of the right ankle,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also forwarded “bilateral pes planus.”  The PEB adjudicated osteochondral lesion of the talus as unfitting, rated 20%.  The right ankle sinus tarsi condition was determined to be Category II condition (related) and the bilateral pes planus condition was determined to be a not unfitting Category III condition.  The CI made no appeals and was separated.

CI CONTENTION:  “I feel the med board did not take into account the long term effects that my ankle injury would have on my life. There is no cartridge in my joint and I have already started to develop arthritis in that foot.  Also the issues with my back were never addressed and that injury has been even more debilitating over the years.  These two injuries are something that has changed my life forever and isn’t something that will go away, I have 3 kids and their whole lives have been affected by my injuries. Not being able to bend over and pick up your kids is something no person should have to live with.”[sic]

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 talus bone and related ankle conditions as well as the not unfitting pes planus condition are addressed below.  The requested back condition was not identified by the PEB and is not within the DoDI 6040.44 defined purview of the Board.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 Board for Correction of Naval Records.

RATING COMPARISON:

Service  IPEB – Dated 20040604	VA - (~ 1.5 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Traumatic Osteochondral Lesion of the Talus	5099-5003	20%	Residuals of Osteochondral Talus Defect/Fracture Right Ankle	5010-5271	10%	20040602	
Sinus Tarsi Syndrome of the Right Ankle 	Cat II					
Bilateral Pes Planus	Cat III	Bilateral Pes Planus	5276	10%	20040602	
Other x 0 (Not in Scope)	Other x 4 	20040602	
Rating:  20%	Combined Rating:  40%	
Derived from VA Rating Decision (VARD) dated 20040818 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Ankle, Traumatic Osteochondral Lesion of the Talus.  The CI experienced right ankle injuries during training.  An X-ray in January 2001 demonstrated the presence of an osteochondral defect in the talus bone of the ankle (zone of impact damage to the joint surface caused by ankle sprains from twisting or impact; osteochondritis dissecans).  The CI underwent right ankle surgery on 24 July 2001 for repair of osteochondritis dissecans of the talar dome (a 13 millimeter x 11 millimeter fragment of bone on the joint surface that had fractured from the surrounding bone).  The CI did well following surgery with gradual return to activities.  In February 2003, he sought care for recurrent right ankle pain with activity.  X-rays and computed axial tomography demonstrated degenerative joint disease.  The CI underwent arthroscopy of the right ankle with debridement of degenerative joint disease on 26 June 2003.  Significant degenerative changes (with loss of joint surface cartilage) were noted on arthroscopic examination.  Orthopedic examination on 15 September 2003, recorded a normal gait with right ankle dorsiflexion to 15 degrees (normal 20) and plantar flexion to 45 degrees (normal 45).  Orthopedic examination on 5 January 2004, noted recurrent right ankle pain over the preceding 2 months and recorded right ankle dorsiflexion of 20 degrees and plantar flexion of 40 degrees.  A local injection in the lateral ankle region for inflammation (sinus tarsi syndrome; associated with recurrent ankle sprains) provided partial relief.  The persistent ankle pain prevented return to full activities required for his military duties.  The MEB narrative summary (NARSUM) performed on 8 March 2004 reported the CI was unable to run or stand for more than 30 minutes at a time.  On examination the gait was normal.  Ankle dorsiflexion was 5 degrees in both ankles performed with the knee in full extension (which tightens the heel cord; symmetry indicates normal).  Plantar flexion was 50 degrees.  Subtalar joint motion was normal.  At the VA Compensation and Pension examination on 2 June 2004, approximately a month prior to separation, the CI reported continued pain with use.  On examination the gait was normal.  Right ankle dorsiflexion was 14 degrees, and plantar flexion 45 degrees (the uninjured left ankle dorsi-flexed to 18 degrees, and plantar flexed to 45 degrees).  There was no change after repetition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle traumatic osteochondral lesion of the talus 20%, coded 5099-5003 (degenerative arthritis).  The VA rated the residuals of osteochondral talus defect/fracture right ankle 10%, coded 5010-5271 (traumatic arthritis-limitation of ankle motion), citing painful motion and slightly limited motion.  Under the VA Schedule for Rating Disabilities (VASRD) diagnostic code 5271 (ankle limitation of motion) a minimum 10% rating is supported by a moderate limitation of motion; however, the range-of-motion examinations proximate to separation recorded slight limitation of motion which did not support the 10% rating under code 5271.  All members agreed there was evidence to support a 10% rating based on painful motion (§4.59) and functional loss (§4.40).  The talus bone was affected by an osteochondral defect.  VASRD diagnostic code 5273 (malunion of the talus) provides for a 10% rating for moderate deformity and 20% for marked deformity.  The Board did not find evidence that supported more than a moderate deformity of the talus.  The PEB listed sinus tarsi syndrome of the right ankle as a condition related to the primary unfitting right ankle condition but not separately ratable (Category II).  Sinus tarsi syndrome refers to lateral ankle pain that can accompany recurrent ankle sprains.  In accordance with §4.14 (avoidance of pyramiding), two ratings cannot be granted for the same impairment.  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 right ankle condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the bilateral pes planus was not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Pes planus was noted on the MEB NARSUM examination however service treatment records reflect treatment for ankle pain but not for impairment due to pes planus.  The condition was reviewed and considered by the Board.  There was no performance based evidence from the record that the pes planus condition significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the pes planus condition and so no additional disability rating is recommended.

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 right ankle traumatic osteochondral lesion of the talus condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended pes planus conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130915, 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 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 13 May 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their 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:

-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX , former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN