RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01544
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150327
SEPARATION DATE:  20040624

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Supply Clerk) medically separated for peroneal rentinacular tear.  The ankle condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  “Peroneal rentinacular tear, status post surgery,” “talar ocd [osteochondral defect] and tibial ocd, status post debridement,” and “anterolateral corner synovitis, status post debridement,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “peroneal rentinacular tear, status post surgery” as unfitting, rated 20% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be related Category II conditions (contributing to unfit).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I am unsure if or what Rating I received.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

IPEB – Dated 20040402	VA - STR	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Peroneal Rentinacular Tear, Status Post (s/p) Surgery

5099-5003	

20%	Residuals of s/p Repair of Superior Peroneal
Retinaculum and s/p Arthroscopic Synovial
Debridement and Drilling of Chondral Lesion of The Right Ankle	5299-5271	0%	STR	
							
Talar OCD And Tibial OCD, s/p Debridement	

CAT II					
Anterolateral Corner Synovitis, s/p Debridement						
Other x 0 (Not In Scope)	Other x 1 	
RATING:  20%	RATING:  0 %	
*Derived from VA Rating Decision (VARD) dated 20050302(most proximate to date of separation (DOS).

ANALYSIS SUMMARY:

Right Ankle Condition.  The CI injured his right ankle while playing basketball in October 2002.  X-rays revealed no boney fracture.  He was diagnosed with a sprain and treated conservatively to include a short leg walking cast.  Follow-up examination clinically revealed ankle instability with possible rupture of adjacent tendons surrounding the ankle.  A magnetic resonance image was abnormal, but not specific in differentiating between boney and or tissue disruption.  On 18 November 2002, the CI underwent surgical repair of the right peroneal retinaculum (a fiborous band of tissue that binds the peroneal muscle/tendon to the outside of the ankle and hind-foot).  Initially, his post-surgical recovery went well.  Within 18 weeks he was able to complete a three mile run in 24 minutes; although still complaining of pain and stiffness.  Repeat X-rays indicated a “possible” loose body within the joint and on 28 April 2003, he underwent a second surgery to retrieve what turned out to be a buildup of inflamed tissue (synovitis).  Additionally, the surgical report noted areas of degenerative cartilage.  Physical rehabilitation, immobilization and restrictions did not resolve his painful condition and therefore a MEB was initiated.

At the MEB narrative summary (NARSUM) examination on 18 December 2003 (6 months prior to separation), the CI reported continued right ankle pain and swelling with impact activities.  His physical examination revealed soft tissue swelling, effusion, and tenderness about the right ankle.  There was painful and limited range-of-motion (ROM).  His diagnosis remained as the listed surgical procedure as well as two degenerative and inflammatory conditions discovered at surgery (osteochondral defect [OCD]; a specific area of injury to the cartilage and or bone within a joint).  The commander’s non-medical assessment implicated the CI’s ankle condition and expressed confidence that with rehabilitation the CI would be able to perform as a Marine.

The VA examination was not available for review, but a VARD (proximate to separation) indicated an original 0% rating was due to ‘failure to report’ for the examination.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Ankle ROM
(Degrees)	Ortho ~ 15 Mo. Pre-Sep
	MEB ~ 6 Mo. Pre-Sep
	VA C&P ~NO SHOW	
Dorsiflexion (20 Normal)	-	10	-	
Plantar Flexion (45)	45	25	-	
Comment	altered gait; tenderness	effusion; tenderness; painful motion	-	
§4.71a Rating	10%-20%	20%	NR	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB’s 20% rating analogous to 5003 (degenerative arthritis) was documented without citings under “findings comments.”  The VA analogously coded under 5271 (ankle; limited motion) at 0% for examination “no show.”  The s/p debridement of the talar and tibial OCD and s/p debridement of the anterolateral corner synovitis were both adjudged as Category II and were correctly considered related to the primary unfitting ankle condition and disability was included under the current PEB rating code.

The Board members then deliberated over two alternate primary VASRD codes of 5271 (limited motion) or 5284 (foot injury; other).  The PEB’s current rating of 20% is equivalent to the maximum allowed under 5271; therefore, the Board’s focus was to determine if the severe (30%) level was met under 5284; noting the intricate anatomic association of the involved tissue about the ankle as well as the foot.  Board members agreed that the most complete examination near the time of separation was the NARSUM whose physical findings would rate no greater than “moderately severe” under code 5284; again, yielding the same impairment of the PEB’s 20%.  In the absence of ankylosis (frozen joint) or astragalectomy (surgical removal of the talus), there are no other alternate ankle joint codes available.  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.

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 right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended debridement of the talar and tibial OCD and debridement of the anterolateral corner synovitis conditions, the Board unanimously recommends no change from the PEB determinations as Category II, contributing to unfitting condition.  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 20130920, 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 25 Jun 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 USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX , former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXXXX, former USN