RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00420
BRANCH OF SERVICE:  MARINES	SEPARATION DATE:  20080531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Rifleman, medically separated for “right ankle pain and stiffness” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20080325	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Pain and Stiffness	5271	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Chronic Right Ankle Pain and Stiffness.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered a severe strain injury of his right ankle in April 2007.  This required reconstructive surgery (modified Broström) in June 2007 followed by a second surgery (posterior tenolysis) in August 2007 (9 months before separation).

The panel consensus determined there were no post-operative STR entries that suggested any more significant range of motion (ROM) limitation or functional impairment, and none that documented any additional VASRD-ratable findings.  The final surgical results were insufficient to allow unrestricted duty and the CI was referred for an MEB.

A 12 December 2007 civilian orthopedic note, 6 months before separation, documented “doing well...some stiffness in the morning and limitation on extreme activity;” and, recorded dorsiflexion to “about 10” degrees (normal 20) and “normal” plantar flexion.

At the 27 February 2008 NARSUM examination, 3 months before separation, the CI complained right ankle stiffness and pain with prolonged standing and walking; inability to jog, run, or play sports.  Physical examination recorded well healed surgical scars (no comment regarding joint tenderness or swelling), mildly decreased dorsiflexion strength (4/5); other motor and sensory test were normal.  ROM was dorsiflexion to 0 degrees and plantar flexion to 20 degrees (normal 45) without comment regarding painful motion.

There was no VA examination in evidence for the panel to review.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5271 (ankle, limitation of motion) did not cite a rationale.

The highest rating under code 5271 is 20% for “marked” limitation.  The panel majority found there was no criterion supported by the evidence that would justify a rating higher than 10% under any other applicable code, barring concession to a 20% rating under code 5271.  This included consideration of analogous rating under code 5262 (tibia and fibula, impairment) which offers ratings for contiguous ankle disability, but, members agreed that the analogous application of this fracture code was not sufficiently justified in a case such as this which satisfies compensable criteria under more applicable codes.

Members deliberated the higher option of code 5271; but, the panel consensus was that the ROM evidence was better aligned with the “moderate” criterion than with the “marked” one.  The civilian orthopedic examiner noted well preserved ROM; and, the NARSUM noted a 66% reduction in plantar flexion, the more functionally important excursion (step off, propulsion, etc.).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), panel consensus was that there was insufficient cause to recommend a change in the PEB adjudication of the right ankle condition.

BOARD FINDINGS:  In the matter of the chronic right ankle pain and stiffness condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.   The single voter for dissent recommends a modification to 20% and does not elect to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS

Subj: PHYSICIU. DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDAT IONS Ref:	(a) DoDI 6040.44
In accordance with reference (a), I have reviewed the cases listed below and 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 USMC
-	XXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXX, former USMC
-XXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXX, former USMC
-	XXXXXXXXXXXXXXXXXX, former USMC

                        XXXXXXXXXXXXXXXXXX
                        Acting