RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxx	CASE:  PD-2014-00199		
BRANCH OF SERVICE:  NAVY	Separation Date:  20061226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Mobile Vehicle Inspection Team Member) medically separated for a right ankle condition.  The right 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 (LIMDU) and referred for a Medical Evaluation Board (MEB).  “Acquired musculoskeletal deformity of other specified site,” “contracture of tendon (sheath),” and “pain in joint involving ankle and foot” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “right ankle pain” as unfitting, rated 10%.  Gastroc equinas contracture (shortening of calf muscle) and osteochondral defect, right talus were adjudicated as Category II conditions (contributing to the unfitting condition).  Upon request for reconsideration, the Reconsideration PEB affirmed the IPEB findings and rating.  The CI made no appeals and was medically separated.  

CI CONTENTION:  He was not evaluated for a left eye condition.  His complete submission is at Exhibit A. 

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 Veterans Affairs Schedule for Rating Disabilities (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:  

Recon IPEB – Dated 20060809	VA* - (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5271	10%	Ankle Pain…S/P Arthroscopy Osteochondral Defect, Right Ankle	5271	20%	20061026	
Gastroc Equinas …	Cat II					
Osteochondral Defect…	Cat II 					
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8 	
RATING:  10%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20070508 (most proximate to date of separation (DOS)).  
ANALYSIS SUMMARY:  The PEB adjudicated the gastroc equinas contracture and osteochondral defect, right talus conditions as Category II conditions - contributing to the unfit ankle condition.  These two conditions will be discussed under the unfitting right ankle condition.  

Right Ankle Condition (Including Gastroc Equinas … and Osteochondral Defect…).  The CI injured his right ankle in April 2004.  Right ankle X-rays in June and December 2004 showed an avulsion fracture.  An MRI in February 2005 showed a small osteochondral defect in the medial aspect of the talus.  The CI underwent a diagnostic ankle arthroscopy and debridement of synovitis and repair of the micro fracture in the talus in March 2005.  Despite Orthopedics evaluations and extensive Physical Therapy treatments, the CI continued with chronic right ankle pain.  An MRI in August 2005 showed no significant change in the osteochondral injury and mild osteoarthritic changes in the medial joint compartment.  The CI was placed on LIMDU from 20 October 2005 to 20 February 2006 for the right ankle pain with restrictions of no running, jumping, or prolonged standing greater than 15 minutes, and wear of tennis shoes.  

The MEB Narrative Summary (NARSUM) exam approximately 6 months prior to separation documented that the ankle pain was worse when the CI walked up hills and wore his boots.  Additional history was noted in the CI’s Request for Reconsideration (undated) which noted three ER visits for the ankle, as well as anticipated future surgery.  The MEB NARSUM physical exam findings are summarized in the chart below.  

The VA Compensation and Pension (C&P) Orthopedic exam approximately 2 months prior to separation documented that the CI continued to have ankle pain, swelling, unsteadiness and limited walking ability.  He rated the pain at 9/10 over the mediolateral aspect with accompanied swelling with limitation of motion.  There was accompanying popping and grinding sensation.  The VA C&P physical exam findings are summarized in the chart below.  

There were two goniometric range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.  

Right Ankle ROM
(Degrees)	MEB ~6 Mo. Pre-Sep	VA C&P ~2 Mo. Pre-Sep	
Dorsiflexion (20 Normal)	10	10	
Plantar Flexion (45)	30	20	
Comments:  	Tenderness to palpation (TTP) lateral joint line; no instability; motor/sensory intact	Painful motion; abnormal gait; TTP; unable to do heel/toe; no instability; ankle brace; motor weakness 4/5 (pain); no atrophy; DeLuca neg	
§4.71a Rating	10%-20% (PEB 10%)	10%-20% (VA 20%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the right ankle condition as 5271 (ankle, limited motion of) rated 10% with two related Cat II diagnoses noted above.  The VA coded the right ankle condition as 5271, rated 20%.  The pre-separation VA C&P exam was closest to separation and indicated slight worsening of ankle pain and ROM with continued significant functional impairment.  The Board deliberated between the 10% (moderate) and 20% (marked) rating (which is the highest rating for this disability code).  There was no ankylosis (frozen joint), malunion, or marked deformity proximate to separation for any alternative coding or higher rating.  The ROM limitations noted throughout the entirety of the record and the above exams were adjudged as being moderate by the majority of the Board.
  
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority 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 majority recommends no change in the PEB adjudication.  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 20131231 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 2 Dec 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 USN
- XXXXXXXXXXXXXXXXXXXX, former USN  
- XXXXXXXXXXXXXXXXXXXX, former USN  
- XXXXXXXXXXXXXXXXXXXX, former USN  
- XXXXXXXXXXXXXXXXXXXX, former USN  
- XXXXXXXXXXXXXXXXXXXX, former USN

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	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)