RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03574
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20090130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Automated Support System Technician, medically separated for “left ankle posttraumatic degenerative joint disease,” with a disability rating of 10%.

CI CONTENTION:  The CI contended that his ankle condition deteriorated and required another surgery.  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 on 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 – 20081117	VARD - 20100318	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle, Joint Disease	5099-5003	10%	Left Ankle, Status Post Fracture, with Post Traumatic Degenerative Disease	5271	0%	STR	
Left Ankle Fracture	Category II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Ankle, Degenerative Joint Disease (DJD).  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left ankle surgery in August 2007, following a fracture.  At the time of the physical therapy appointment on 14 December 2007 (13 months prior to separation), the CI reported constant left ankle and foot pain (rated 5/10 severity) with activity or walking.  He was ambulating with a crutch.  On examination, the ankle was reported as bearing only partial weight, with reduced strength recorded at 3+/5 dorsiflexion, toe extension & flexion, and eversion (rolling the ankle to position the foot outward in a lateral direction).  The CI could not perform a calf raise.  The surgical scars were healing, tender and adhesed.  On examination the left ankle range of motion (ROM) was dorsiflexion 17 degrees (normal 20 degrees) and plantar flexion of 30 degrees (normal 45 degrees).   The Primary Care clinic examination dated 22 July 2008, 6 months prior to separation, reported CI complaints of fluid buildup and worsening pain with weight bearing for 2 days prior to the appointment.  ROM was noted to be diminished and there was increased pain with dorsiflexion and eversion.  The CI was ambulating with a cane.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “unspecified closed fracture of ankle” and “osteoarthrosis, unspecified whether generalized or localized, ankle and foot” for PEB adjudication.

At the MEB NARSUM examination on 25 September 2008 (4 months prior to separation), the CI reported pain with running, prolonged walking, prolonged standing, or any type of impact activities.  The pain was worse in the mornings and with cold weather.  His ankle pain was improved by rest and medication.  He used a cane “for ambulatory assistance for long distances.”  Physical examination (PE) of the left ankle revealed well-healed surgical scars, and some tenderness to palpation.  There was no ligamentous laxity, and sensation was intact.  X-rays showed the healed fracture and intact surgical hardware.  On examination the left ankle ROM was dorsiflexion 20 degrees (normal 20 degrees) and plantar flexion of 20 degrees (normal 45 degrees).   

The VA did not perform a Compensation and Pension (C&P) examination. 

The Board directed attention to its rating recommendation based on the evidence.  The PEB assigned 10% rating using an analogous 5099-5003 code (degenerative arthritis).  The VA assigned a 0% using the 5271 code (limited motion of the ankle), citing lack of moderate limitation of motion of the 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 ROM of the ankle.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 10% rating adjudicated by the PEB.  The Board determined the left ankle fracture adjudicated as a related Category II condition was properly subsumed by the PEB in the unfitting left ankle posttraumatic degenerative joint disease, so no separate rating for that condition is recommended.  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 unfitting left ankle condition. 

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left ankle fracture, the Board unanimously recommends no change in the PEB determination as Category II.  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 20140727, 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 10 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC