RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00609
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20081230

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “right ankle pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  His 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 upon a 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 - 20081104	VARD-NA 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5099-5003	10%	No VA Examination in Evidence
	
Ankle Fracture Post-operatively Treated	CAT II		
Right Ankle Fracture: Healed Fibular Fracture with Intact Syndesmosis			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI fractured his ankle (spiral fracture of the distal fibula) 1 month after entry during pugil stick training.  He underwent surgery (open reduction and internal fixation-ORIF) in May 2008.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “unspecified closed fracture of ankle,” “other postsurgical status” and “pain in joint involving ankle and foot” for PEB adjudication.
At the time of the orthopedic clinic appointment on 1 August 2008 (5 months before separation), the physical examination documented dorsiflexion of 10 degrees (normal 20) and plantar flexion of 20 degrees (normal 45) with no tenderness or instability.  During the MEB examination on 22 September 2008 (3 months before separation), the physical examination showed tenderness, swelling, and decreased dorsiflexion.  At a follow-up orthopedic appointment on 3 October 2008, the CI reported pain with walking, stiffness and swelling.  The physical examination documented dorsiflexion of 15 degrees and plantar flexion of 35 degrees, without tenderness or effusion.  At an orthopedic examination 1 week later, the CI denied pain with “non-impact” exercise.  The physical examination documented dorsiflexion of 15 degrees and plantar flexion of 35 degrees, with no tenderness or effusion.  

At the MEB NARSUM on 15 October 2008 (2 months before separation), the CI reported pain and stiffness.  The physical examination documented dorsiflexion of 15 degrees and plantar flexion of 35 degrees with minimal joint effusion.  Radiographic imaging reportedly showed a healed fibula fracture and well-aligned hardware.  The CI has not filed a compensation and pension claim with the VA.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5099-5003 (analogous to degenerative arthritis).  The Board considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  The Board agreed that the ROM examinations proximate to separation detailed above were consistent with a moderate limitation of motion for the 10% rating under this code.  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.  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.  

The PEB also listed ankle fracture post-operatively treated and right ankle fracture; healed fibular fracture with intact syndesmosis as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from the conditions were properly subsumed under the overall rating for the right ankle pain condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  

BOARD FINDINGS:  In the matter of the right ankle 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 20150602, 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 15 Nov 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)