RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02664
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20020330

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

CI CONTENTION:  Consider all conditions.  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 based upon a 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 - 20020201	VARD - 20040207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Ankle Pain	5299-5003	10%	Recurrent Left Peroneal Tendon Tears Status Post Repairs with Left Ankle Weakness Instability and Pain	5271	10%	STR	
Functional Left Ankle Instability						
Weakness, Left Peroneal Tendons	Related to Left Ankle Pain					
Recurrent Left Peroneal Tendon Longitudinal Tears, Status Post Left Peroneal Tendon Repairs and Left Peroneal Groove Deepening						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Ankle Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’ left ankle pain started in July 1998 after a fall down a set of stairs.  The CI then sustained multiple left ankle injuries culminating in surgery in April 1999 for a left peroneal tendon repair and deepening of an aplastic peroneal groove.  The CI underwent physical therapy, casting, and bracing, modification of activity and use of nonsteroidal anti-inflammatories.  However, the CI had multiple additional sprains and continued to have pain in her left ankle.  The MEB forwarded “recurrent left peroneal tendon longitudinal tears, status-post left peroneal tendon repairs and left peroneal groove deepening, weakness, left peroneal tendons compared to right one grade , functional left ankle instability and chronic left ankle pain” for PEB adjudication.  

The MEB NARSUM examination on 15 October 2001, 6 months prior to separation, noted some complaints of instability, but pain was the CI’s major complaint.  Numbness and tingling were denied.  The CI felt that she had weakness and giving away of her ankle.  Physical examination noted the CI walked with a limp.  She was able to do a heel-walk and toe-walk, but with pain.  There was obvious crepitus and popping over her peroneal tendons with circumduction of her ankle both in internal and external rotation.  There was no significant swelling.  Strength to her peroneal tendons was reported as 4/5 (the examiner questioned if this was true weakness or as a result of painful motion).  There was normal sensation and good capillary refill.  She also had an anterior drawer, but was noted to be “minimally so.”  The left ankle range of motion was dorsiflexion approximately 10 degrees (normal 20) and plantar flexion of 40 degrees (normal 45), with pain.  

There was no VA Compensation and Pension examination in evidence, the VA used the STR for evaluating the left ankle condition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, analogously coded 5003 (arthritis, degenerative).  The PEB noted left ankle instability, weakness, left peroneal tendons and recurrent left peroneal tendon longitudinal tears, status post left peroneal tendon repairs and left peroneal grooved deepening as conditions related to the left ankle pain.  The VA rated recurrent left peroneal tendon tears, status post repairs with left ankle weakness, instability and pain 10% coded 5271 (ankle, limited motion of), based on the STR, citing moderate limited motion of the left ankle.  The Board considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  All Board members agreed the limitation of motion was no more than moderate, therefore supporting the 10% rating adjudicated by the PEB.  A higher rating of 20% was not indicated in the absence of marked limited range of motion of the ankle.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous 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 left ankle condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that functional left ankle instability, weakness, left peroneal tendons compared to right and recurrent left peroneal tendon longitudinal tears, status-post left peroneal tendon repairs and left peroneal groove deepening were not separately unfitting, but instead related to the chronic left ankle pain.  Board members agreed with the PEB that all of these conditions were part of the overall ankle pain condition and that in accordance with VASRD §4.14, avoidance of pyramiding, would not be separately rated using the same symptoms or physical signs.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination that functional left ankle instability, weakness, left peroneal tendons compared to right and recurrent left peroneal tendon longitudinal tears, status-post left peroneal tendon repairs and left peroneal groove deepening so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic left 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 20140422, w/attachments
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 14 Nov 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:

		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN