RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03199
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060907

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Hull Technician, medically separated for a “left ankle condition,” with a disability rating of 20%.

CI CONTENTION:  The CI contends for his unfitting ankle and conditions not identified by either the MEB or PEB.  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 - 20060817	VARD - 20070119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthrosis Navicular and Surrounding Joints and Subtalar Joint	5271	20%	Right Ankle Sprain	5271	NSC	20061211	

Closed Fracture Talus	Cat II	Residuals of Fractures of the Navicular and Talus Left Foot Bones with Open Reduction to Include Residual Scar and Degenerative Arthritis	5010-5284	20%	20061211	
Closed Fracture Left Navicular	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Posttraumatic Arthrosis Navicular and Surrounding Joints and Subtalar Joint.  According to service treatment records (STRs), the CI underwent left ankle surgery in November 2005 for lateral talus and navicular bone fractures. Despite treatment, the ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “closed fracture of unspecified bone(s) of foot [except toes]; closed fracture of astragalus; and osteoarthrosis, unspecified whether generalized or localized, ankle and foot,” for PEB adjudication.

At an orthopedic clinic visit in April 2006, 5 months post-surgery, physical examination noted increased range of motion (ROM), and pain present with palpation.  At a physical therapy visit in June 2006, 3 months pre-separation, the CI reported he was satisfied with his movement and strength, but that pain was his problem.  Physical examination noted tenderness to palpation, crepitus, and a moderate antalgic gait.  ROM measurements were 60 degrees plantar flexion (45 normal), and 5 degrees dorsiflexion (20 normal). 

The MEB narrative summary (NARSUM), written in July 2006, 2 months pre-separation, indicated the CI complained of continued pain.  Physical examination noted the CI left lower extremity is distally neurovascular intact, dorsalis pedis pulses are 2+, strength is 5/5, and sensation is intact to light touch.  At the VA Compensation and Pension (C&P) examination in December 2006, performed 3 months after separation, the CI reported no ankle or foot pain at rest, with pain and stiffness after standing and walking for about an hour.  There has been no swelling or instability.  Physical examination showed moderate enlargement of the left lateral malleolus.  The Board directed attention to its rating recommendation based on the above evidence. 

The PEB assigned a 20% rating under the 5271 code (limited motion of the ankle).  The VA also assigned a 20% rating using an analogous 5010-5284 code (arthritis, due to trauma, and foot injuries, other) based on the VA C&P examination 3 months after separation, citing a moderately severe foot injury.  The VA also identified the condition of right ankle sprain, coded 5271, as not service-connected.  The board noted the two additional diagnoses determined to be Category II conditions (conditions that contribute to the primary unfitting condition but are not separately ratable) were intertwined diagnoses and the overall ankle impairment from all listed diagnoses were subsumed under the ratings for the ankle by both the PEB and the VA.  More than one rating based on the same impairment is prohibited (§4.14 avoidance of pyramiding).

The Board noted that the PEB assigned the maximum rating (20%) available under the diagnostic code 5271, supported by the presence of a moderate antalgic gait and crepitus noted in the physical therapy visit 3 months prior to separation.  The Board also considered whether a higher rating was supported under other diagnostic code options.  Because there was no ankylosis, nonunion or mal union, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 20% rating adjudicated by the PEB.  The Board also considered whether ratings under the VASRD code for other foot injuries (5284) provided for a higher rating (§4.7) however all Board members agreed that the severe level (30%) was not supported.  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.

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71a, the Board unanimously or majority 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 20140701, 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 24 Jun 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:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC 

						 XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						 (Manpower & Reserve Affairs)