RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01120
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20071015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Aircraft Maintenance Administration Specialist) medically separated for right ankle pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The “other joint derangement, not elsewhere classified, ankle and foot,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right ankle pain and mild instability with an osteochondral lesion” as unfitting, rated 10%.  The CI made no appeals and was medically separated.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  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 Veteran’s 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:  

IPEB - Dated 20070712	VA* - (10 Days Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain and Mild Instability with an Osteochondral Lesion	5299-5003	10%	Right Ankle, Status Post Arthroscopic Removal of Loose Bodies and Debridement of Talar OCD Lesion	5271	10%	20071005	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 13	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20080620 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right Ankle Pain and Mild Instability with an Osteochondral Lesion.  The record shows that the CI sprained his right ankle in November 1995.  He was improving with duty restrictions and medications when his ankle was reinjured approximately 2 weeks later.  He was in formation with his heels apart; a drill instructor kicked them together with the recurrent pain resulting.  Over the ensuing 10 years, he was seen periodically for both ankles, but primarily for the right.  He was evaluated in podiatry on 3 April 2006 for recurrent sprains of the right ankle necessitation the use of crutches.  X-rays showed some degenerative joint disease (DJD) and a CT was accomplished 3 days later.  It showed some loose bodies in the joint and degenerative changes of the cartilage over one of the ankle bones (talus).  These findings were treated surgically on 17 May 2006.  He was referred to physical therapy (PT) for rehabilitation and his function improved, but he was unable to return to full duty status and entered into the MEB process after his second LIMDU period.  The narrative summary (NARSUM) was dated 1 May 2007, 5 months prior to separation.  The CI reported that he could not run and had stiffness of his ankle if he stood for a long period of time.  The range-of-motion (ROM) was slightly reduced and painful motion was not documented.  One assessment of instability was present on the right compared to the left.  He was diagnosed with right ankle pain and mild instability.  At the MEB examination a week later, the CI had limited ROM and was tender over the ankle bones.  At the VA Compensation and Pension (C&P) examination performed on 5 October 2007, 10 days before separation, the CI reported that he was unable to run or to walk long distances without frequent stops.  He could climb stairs and take out the trash, but could not vacuum, drive a car, or push a lawn mower.  His posture and gait were normal.  There was guarding of movement and motion was painful.  Instability (subluxation) was not present.  The ROM was normal.  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)	MEB ~5 Mo. Pre-Sep	PT ~5 Mo. Pre-Sep	PT ~4 Mo. Pre-Sep	VA C&P 10 Days Pre-Sep	
Dorsiflexion (20 Normal)	15	5	5	20	
Plantar Flexion (45)	43	45 (60)	45 (60)	45	
Comment	+ Talar tilt; non-antalgic gait	Inversion painful; minimal limp	Eversion painful; walking more comfortable; able to run 200 feet	Painful motion	
§4.71a Rating	10%	20%	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the ankle at 10%, coded 5299-5003 (analogous to degenerative arthritis).  The VA also rated the ankle at 10%, but coded it 5271 (limitation in motion) at a moderate degree.  The Board considered the evidence.  Although the CI was unable to meet duty standards, the record shows that the CI was improving in his function in the months leading up to separation even though the measured dorsiflexion remained low.  The VA examination, the most proximate to separation, was essentially normal other than painful motion.  This is consistent with the trend of improvement noted in the clinical records.  The VA examination is therefore assigned the highest probative value.  It supports the 10% rating adjudicated by the PEB and VA.  While the 5271 code used by the VA better describes the clinical disability, it provides no rating advantage to the CI.  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 pain condition and IAW VASRD §4.71a, the Board unanimously 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 20140301, 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 4 Jan 16

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

						  XXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)