RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01606
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20091129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Infantry, Rifleman and Martine Security Guard, medically separated for “chronic right ankle pain” with a disability rating of 10%.

CI CONTENTION:  Contends his 10% right ankle PEB rating in comparison to his 20% VA rating and combined 70% VA rating.  The CI’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:

SERVICE PEB - 20090915	VARD - 20100521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain	5099-5003	10%	Right Ankle Condition	5270	20%	20100218	
S/P Right Ankle Watson-Jones Stabilization	Category 2					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Right Ankle.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right ankle surgery in September 1997 for lateral instability.  He completed post-operative physical therapy and returned to full duty.  He re-experienced instability after multiple inversion injuries from December 2008 to January 2009.  At a physical therapy evaluation on 28 May 2009, there was no laxity and the range of motion (ROM) was full and pain free.  In orthopedics on 17 June 2009, the CI reported subjective instability; however, the ankle was stable on examination.  “Active dorsiflexion and plantar flexion” was documented without quantification, but normal motor function was documented implying functional ROM.  Despite treatment, the right ankle back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded pain in joint involving ankle and foot, and Watson-Jones stabilization for PEB adjudication.

The MEB NARSUM was performed on 25 July 2009 (4 months prior to separation).  The examination noted previously healed surgical incisions with diffuse tenderness to palpation.  The ROM was reduced and is charted below.  His motor strength was normal and the ankle was stable.  X-rays revealed post-operative changes.  At a physical therapy appointment on 5 August 2009, the ankle motion was noted to be normal, but painful.  Instability was absent.  During a military treatment facility visit on 10 September 2009, the CI reported ongoing ankle pain.  He had diffuse tenderness to palpation.  He could weight bear to 100% and the ankle was stable.  He was diagnosed with chronic right ankle pain with continued pain medications.  No comment was made on motion or gait.

The VA Compensation and Pension (C&P) examination was performed on 18 February 2010, 3 months after separation.  It was noted that the CI had prior trauma as a child in addition to the in service injuries.  He reported that his right ankle locked and hurt.  Running hurt, but walking was unlimited.  Anterior joint line “popping” was noted with active ROM.  The examination showed instability.  He had tenderness to palpation over the ankle bones.  He had no additional limitations with repetitive motion.  His motor function was normal as was his gait.  He was able to heel-toe walk without difficulty, implying good function of the ankle.  His X-rays were consistent with a remote history of trauma.  A physical medicine note dated 10 March 2010 also noted a normal gait.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5099-5003 (analogous for degenerative arthritis).  The VA granted a 20% coded 5270 (ankle ankylosis), citing VASRD criteria.  The Board noted that the PEB ROM values support a 20% rating for limitation in motion while the VA values support a 10% rating.  These are considered to be equally probative as individual examinations.  However, the Board noted that the CI was recorded as having normal ROM in physical therapy evaluations before and after the MEB examination and a normal gait on multiple examinations.  The VA examination more closely reflects the totality of the evidence.  Under VASRD diagnostic code 5271 (ankle limitation of motion), a minimum 10% rating is supported by a moderate limitation of motion.  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:  In the matter of the right ankle 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 20140407, 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 12 Apr 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:

		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USMC