RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01286
BRANCH OF SERVICE:  NAVY  	SEPARATION DATE:  20080320 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Air Traffic Controller) medically separated for right ankle pain with documented mild medial talar dome OCD (osteochondritis desiccans) rated 10%.  

CI CONTENTION:  The CI asserts he was unfairly rated at 10% by the PEB for a condition which was rated at 30% by the Veterans Administration less 2 months after his discharge.  He further contends that if the PEB had rated the in his right ankle which was aggravated by a staph infection he would have received a medical retirement.  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 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 2001203	VA* - (~2 Mos. Post-Separation)  -	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain with Documented Mild Medial Talar Dome OCD…	5299-5003	10%	OCD, Right Ankle (to include Staph Infection)	5270	30%	2008527	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3 	
RATING:  10%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20081023 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Right Ankle Pain with Documented Mild Medial Talar Dome OCD (Osteochondritis Desiccans) Condition.  The record shows that on 8 November 2005, the CI missed a bottom step and fell twisting his right ankle.  X-rays showed that he also had a fracture of the bottom of the smaller lower leg bone (fibula) which was fixed with a plate at surgery on 15 November 2005.  Following surgery, he underwent rehabilitation, but never fully recovered.  He was able to meet duty requirements in garrison, but could not meet all physical fitness requirements and was not qualified for unrestricted duty.  On 9 June 2006, a CT scan showed degeneration of the cartilage of an ankle bone (talus) which was treated surgically on 19 July 2006.  This was complicated by a soft tissue (non-bony) infection which was treated with IV antibiotics.  On 7 September 2006, he was noted to be recovering well with full ankle motion.  He was again rehabilitated in physical therapy, but not able to return to full duty.  An X-ray on 31 July 2007 showed a possible cartilage defect of the talus.  He was then recommended for an MEB.  A sports medicine evaluation dated 16 October 2007 recorded that the CI had increased pain with prolonged standing, walking, and running.  He used an elliptical trainer for fitness and had mild pain if he kept it at the lowest setting.  His pain was greatest with dorsiflexion (toes up) and improved after push-off.  The dorsiflexion range-of-motion (ROM) was reduced and painful.  The ankle was diffusely swollen, but non tender.  The narrative summary (NARSUM) was dated 30 October 2007, 5 months prior to separation.  The ROM values duplicated those of the 16 October 2007 orthopedic evaluation.  His gait was normal.  It was noted that his symptoms were mild and tolerable with significant activity modifications, but not compatible with full military duty.  Inversion and eversion were 10 degrees each on the right and 20 degrees each on the left.  At the MEB examination on 1 November 2007, the examiner noted that the right ankle was swollen.  The ROM was recorded as normal in dorsiflexion, plantar flexion (toes down), inversion, and eversion.  No comment was made on gait, but his balance was noted to be normal.  At the VA podiatry Compensation and Pension (C&P) examination performed on 27 May 2008 approximately 2 months after separation, the CI reported that he could not stand or walk without pain, but did not use an assistive device other than orthotics.  These provided minimal relief.  The ROM was severely restricted with dorsiflexion limited to (-) 10 degrees (10 degrees of plantar flexion) and 40 degrees of plantar flexion.  Inversion and eversion were painful and restricted.  The ankle was painful to palpation.  He was noted to have an equinus deformity (high arch).  One week later, the general C&P examination noted a normal gait and documented no time lost from work the past year.  The Board was unable to reconcile the limitations in motion on the podiatry examination with the documented normal gait one week later.  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)	Mil. Med ~8 Mo. Pre-Sep	Ortho ~5 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
Dorsiflexion (20 Normal)	Slightly Restricted	10 (right 30)	-10	
Plantar Flexion (45)		15 (right 15)	40	
Comment	Painful motion not recorded	Normal Gait	Painful motion	
§4.71a Rating	10%	10%	20/30%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle pain condition at 10%, coded 5299-5003 (analogous to degenerative arthritis).  The VA rated the right ankle OCD lesion at 30%, coded 5270 (ankylosis of the ankle), noting the significantly restricted ROM on the podiatry C&P.  The Board considered the evidence.  The orthopedic assessment for the MEB showed limited dorsiflexion, but motion was present.  Two weeks later, the MEB examiner documented normal ROM in all planes.  The VA C&P examiner, a Podiatrist, noted that dorsiflexion was less than neutral at (-) 10 degrees.  However, less than 1 week later, a different examiner recorded a normal gait which is not consistent with the limitations in dorsiflexion the VA podiatrist recorded.  This podiatry examination is also inconsistent with the other examinations in evidence, the physical findings, and the activity level reported by the CI.  The probative value for this examination is accordingly reduced for rating purposes.  The Board considered other coding options and determined that 5271 (limited motion of the ankle) was the best description of the disability present.  It considered if the limitation was better described as moderate or marked.  The CI was recorded as having a normal gait (VA general examination) and normal ROM (MEB 2808).  These do not support a severe level of limitation.  A moderate level of limitation supports a 10% rating.  While the 5271 is thought to be a better code, it provides no rating advantage to the CI and no change is recommended therefore.  The Board also notes for the record that although the VA used the code for ankylosis (5270), ankylosis (fusion) is not present either in actuality or functionally.  The Board also considered if a higher rating could be supported IAW VASRD §4.40 (functional loss), but noted that the CI reported that he was able to meet duty requirements in garrison and that he had missed no days of work from his condition.  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 chronic 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.  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 20140303, 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 19 May 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN