RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03363
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20080723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Master at Arms, medically separated for “type IV osteochondritis dissecans of the anterolateral dome of the talus,” with a disability rating of 10%.  

CI CONTENTION:  Please consider all conditions.

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 - 20080609	VARD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type IV Osteochondritis Dissecans Of The Anterolateral Dome Of The Talus	5099-5003	10%	Status Post Right Ankle Arthroscopy, Debridement Of Osteochondritis Dessicans, And Curettage And Drilling Of Talar Dome With Residual Scars	5003-5271	10%	20090223	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Type IV Osteochondritis Dissecans of The Anterolateral Dome of the Talus Condition.  In May 2005 the CI presented with right ankle pain and swelling.  Magnetic resonance imaging performed on 25 May 2005 revealed an osteochondral lesion in the talar bone, early arthritis of the talonavicular joint, tenosynovitis of the flexor hallucis longus tendon, and chondromalacia of the distal tibia.   A diagnosis of right talar osteochondritis dissecans was rendered and on 12 July 2005 the CI underwent arthroscopic debridement of the lesion.  Post-operatively the CI continued to report right ankle pain and swelling.  The narrative summary (NARSUM) documented that the CI underwent a second arthroscopic debridement of the osteochondral lesion in late 2006.  The NARSUM examination demonstrated an antalgic gait, right ankle swelling, redness in some areas of the ankle, and decreased ankle range of motion (ROM).  

At the VA Compensation and Pension (C&P) examination, performed 7 months after separation, the CI reported daily, mild soreness and constant swelling of the right ankle.  He reported that the ankle did not limit his walking or ability to perform his job as a heavy construction equipment driver.  The physical examination demonstrated a slight limp on the right lower extremity, decreased right ankle ROM, and no right ankle tenderness to palpation or swelling. A diagnosis of chronic right ankle pain due to osteochondral defect and arthritis of the talus was rendered.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Ankle ROM
(Degrees)	PT ~# Mo. Pre-Sep
(20060518) p166	MEB ~3 Mo. Pre-Sep
(20080407 p.38	VA C&P ~7 Mo. Post-Sep
(20090223) p.55	
Dorsiflexion (20 Normal)	10	5	15	
Plantar Flexion (45)	35	20	30	
Comment				
§4.71a Rating	10%	(5271 or 5273) 20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA rated the right ankle condition at 10%, coded 5099-5003 (analogous to degenerative arthritis) and 5005-5271 (degenerative arthritis- moderate ankle limitation of motion).  The Board considered whether the evidence supported a higher than 10% rating.  The Board deliberated rating the condition as marked ankle limitation of motion; however, the NARSUM listed passive ankle dorsiflexion of 5 degree and the VASRD rates active ROM.  Other active ROM measurements documented by physical therapy and VA did not rise to the level of marked limitation of motion.  There was no evidence of ankylosis or malunion of the talus with marked deformity for a higher rating.   Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the right ankle pain condition was appropriately recommended in this case. 

BOARD FINDINGS:  In the matter of the right ankle pain 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 20140707, 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)