RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04144
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20011115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aviation Operations Specialist, medically separated for “persistent pain status post arthroscopy and Brostrom procedure right ankle,” with a disability rating of 10%.

CI CONTENTION:  “Please 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 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 - 20010913	VARD - 20020125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Pain Status Post Arthroscopy and Brostrom Procedure Right Ankle	5299-5003	10%	Right Ankle Surgical Repair with Persistent Disability	5299-5262	10%	20011002	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Persistent Pain Right Ankle.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent arthroscopic right ankle surgery in January 2000 to repair ankle instability (looseness of the ligaments on the lateral ankle as a result of prior ankle sprains) and debridement (removal of abnormal excess tissue) for impingement (pinching with motion) symptoms.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “persistent pain status post arthroscopy and Brostrom procedure right” for PEB adjudication.  

The MEB NARSUM on 10 April 2001 (7 months before separation) noted well-healed surgical scars.  Strength and sensation were reported as normal for the foot, and there was tenderness at the joint.  Pain was recorded “with stressed inversion” motion.  Right ankle range of motion was reported as dorsiflexion 10 degrees (normal 20) and plantar flexion 50 (normal 45).  The ankle ligaments were stable (talar tilt testing).  

At the 2 October 2001 VA Compensation and Pension (C&P) examination, performed 1 month before separation, the CI reported right ankle pain and swelling particularly with exercise or impact and that the ankle also tended to be unstable.  She was using a non-steroidal anti-inflammatory drug regularly and a narcotic pain medication as needed.  On examination, strength, sensation and reflexes were normal.  The examiner noted that the CI was “unable to walk on her right heel or toes because of pain in the ankle” and she was unable to squat or hop on the right foot.  The right ankle showed no abnormalities and the examiner recorded “normal range of motion, but it was tender to flexion and extension of the ankle.”  Dorsiflexion was 20 degrees and plantar flexion was 45 degrees.  Radiographic studies were within normal limits.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle 10% coded analogous to 5003 (degenerative arthritis), citing limited dorsiflexion and pain on stressed inversion.  The VA also rated the right ankle 10%, coded 5299-5262 (analogous to impairment of tibia and fibula), citing pain with squatting or hopping on the right foot.  There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271).  However there was evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45), as adjudicated by the PEB.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  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 right ankle condition.  

BOARD FINDINGS:  In the matter of the persistent pain, right ankle, 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 20140814, 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 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