RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01651
BRANCH OF SERVICE:  NAVY 		SEPARATION DATE:  20070505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Culinary Specialist) medically separated for right ankle.  The 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).  The “traumatic arthropathy involving ankle and foot,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded three other conditions (loose body in joint, ankle, and foot, unspecified site of ankle sprain, and acquired musculoskeletal deformity of other specified site) for PEB adjudication.  The Informal PEB (IPEB) adjudicated “right ankle joint traumatic arthroscopy” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions (right ankle sprain Grade III, right osteochondral defect, and right ankle joint loose body) were determined to be Category II (contributing to unfit) conditions.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  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 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 20070126	VA* - (~1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Joint Traumatic Arthroscopy	5284	10%	Right Ankle, Residuals of Arthroscopy with Scar and Degenerative Changes	5271-5003	10%	20070531	
Right Ankle Sprain Grade III	Cat II					
Right Osteochondral Defect						
Right Ankle Joint Loose Body						
Other x 0 	Other x 9	
RATING:  10%	RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20071030 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  All Category II conditions are considered under rating for the unfitting right ankle condition below.  

Right Ankle Joint Traumatic Arthroscopy (Arthropathy) with Sprain, Osteochondral Defect, and Loose Body.  The narrative summary (NARSUM) and treatment record noted the CI had right ankle arthroscopic surgery in April 2006 for chronic ankle pain following an injury.  Surgery involved removal of a bony lesion (osteochondral defect of the talus with drilling).  Ankle pain persisted following therapy and the CI reasonably declined additional surgery.  

At the MEB exam, performed 6 months before separation the CI reported that he required wear of an ankle brace for comfort and had 6-8/10 ankle pain with prolonged standing or activity.  The MEB physical exam noted significant ankle pain during an antalgic gait.  There were well healed ankle incision scars and tenderness to palpation over the talus.  Range-of-motion (ROM) was 15 degrees of dorsiflexion (normal 20) and 45 degrees of plantar flexion (normal).  There were no neurovascular or motor abnormalities documented.  X-rays showed degenerative changes and CT scan showed bony abnormalities in the talus (large osteochondral defect along the medial talus, with surrounding subchondral cysts).  

At the VA Compensation and Pension (C&P) exam performed a month after separation, the CI reported constant right ankle pain with fatigue, weakness, and lack of endurance but no incoordination.  There was no complaint of discomfort from the scar.  Gait was normal and there was no objective evidence of tenderness, painful motion, weakness, or instability.  ROM was dorsiflexion to 10 degrees (normal 20) and plantar flexion to 45 degrees (normal).  X-ray revealed degenerative changes in the right ankle.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition at 10% under code 5284 (foot injuries, other); "moderate."  The VA rated the ankle condition at 10% using coding of 5271-5003 (ankle, limited motion with the criteria under arthritis, degenerative).  No exams documented marked limited motion or instability.  The Board adjudged that the ankle/foot injury did not more nearly approximate the moderately severe level of foot injury for any higher rating.  There was insufficient evidence that the ankle arthroscopy scar rose to the level of being separately unfitting and ratable.  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.  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 20140403, 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 6 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:

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

					 XXXXXXXXXXXXXXX
	     				 Assistant General Counsel
					(Manpower & Reserve Affairs)