RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01914
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20040315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Helicopter Mechanic, medically separated for left ankle pain with a disability rating of 10%.  

CI CONTENTION:  His conditions continue 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.  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 - 20040115	VARD - 20050919	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Continued Left Ankle Pain	5299-5295	10%	Degenerative Joint Disease Left Ankle	5010-5271	0%	20050825	
Impingement and Peroneal Tendon Subluxation	Cat II					
Right Acute Anterior Shoulder Dislocation	Cat III	Chronic Right Shoulder Strain	5010-5201	0%	20050825	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Continued Left Ankle Pain Condition.  The record shows that the CI fell and fractured his left ankle in July 2002.  He was put in a cast, treated with physical therapy, and placed on LIMDU (limited duty).  However, he continued to have pain with high impact activities.  During the rehabilitation for his ankle, he fell onto his right shoulder and dislocated it.  This required surgery and is addressed below.  Following recovery from the shoulder surgery, he underwent surgical repair of the ankle (peroneal) tendons on 8 August 2003 and was again placed in a cast (for 6 weeks).  After rehabilitation, he regained full range-of-motion (ROM), strength, and stability. His pain persisted though and precluded return to full duty.  The narrative summary (NARSUM) was dated 10 November 2003, 3 months after surgery and 5 months prior to separation.  The examination showed normal ROM with diffuse pain inside the joint albeit without tenderness.  Sensory and motor function was normal.  The gait was not recorded.  At the MEB examination (DD Form 2808) dated 2 December 2003, the examiner recorded tenderness and swelling.  The ROM was full and neurological examination intact.  At the VA Compensation and Pension (C&P) examination performed 17 months after separation, the CI reported continued pain associated with “cracking and popping”, but had not limitations in his occupation or activities of daily living.  His symptoms did increase with activity.  On examination, his gait was noted to be “steady” and no assistive device was in use.  The ROM exceeded VA normal values and painful motion was not recorded.  He could move against resistance without difficulty or fatigability.  While not specifically stated, this implies good stability.  The surgical scars were well healed although discolored.  Popping with ROM was noted.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle pain condition at 10%, coded 5299-5295 (back strain).  The PEB determined that “impingement and peroneal tendon subluxation treated with surgery” was a related condition and intrinsic to the rated condition.  A separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed in the same rating.  The VA rated the ankle condition, described as “degenerative joint disease left ankle, status post repair of subluxation with scar,” at 0%, coded 5010-5271 (traumatic arthritis-limited motion of the ankle).  The Board found no route to a higher rating than the 10% adjudicated by the PEB.  It noted that the code was incorrect though and recommended a change to 5010.  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 left ankle condition, but recommended a change in the code to 5010.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the right shoulder condition was not unfitting.  The NARSUM noted that it presented no limitations.  On examination, he had full ROM and mild symptoms with activity.  The VA C&P examiner noted no functional deficits.  There was no performance based evidence from the record that the right shoulder condition significantly interfered with satisfactory duty performance at separation.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the) contended right shoulder condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left ankle condition, the Board unanimously recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a.  In the matter of the condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right shoulder condition, the Board unanimously recommends no change from the PEB determination as Category III (not unfitting).  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Continued Left Ankle Pain 	5010	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140430, 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 15 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 USMC
		- XXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXX, former USN