RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00737
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20040710

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Boatswains mate, Rigger/Weight Tester, medically separated for “left ankle pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI contended for his unfitting condition.  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 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 - 20040324	VARD - 20040804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Pain…	5271	10%	S/P Right Ankle Reconstruction	5273	10%	20040503	
			Left Ankle Surgical Scar	7805	0%	20040503	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Ankle Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left ankle surgery (Brostrom anatomic lateral ankle reconstruction) in May 2003 for a history of numerous ankle sprains (instability).  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left ankle pain, status post lateral ligament reconstruction” for PEB adjudication.  

The range of motion (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.  

Left Ankle ROM
(Degrees)	PT ~8 Mos. Pre-Sep	MEB ~5 Mos. Pre-Sep	VA C&P ~2 Mos. Pre-Sep	
Dorsiflexion (20 Normal)	WNL	20	20	
Plantar Flexion (45)	WNL	60	45	
Comments:  Surgery ~14 Mos. Pre-Sep	Functional loss/weakness; abnormal bone growth	Tenderness; abnormal bone growth; functional loss	Abnormal gait; inversion deformity; functional loss	
§4.71a Rating	10%	10%	10%	

At the physical therapy clinic examination on 24 November 2003, 6 months post-surgery and 8 months prior to separation, the CI reported decreased left ankle swelling with pain at a scale of 3/10 to the left lateral malleolus (bony projection normally found at the ankle – with shape likened to a hammer head).  Physical examination recorded ROM measurements per chart above.  There was visible bone growth (abnormality/deformity) at the medial malleolus.  Left ankle related gross muscle movements showed slightly decreased strength at 4/5 (5/5 normal) upon testing.  

At the orthopedic clinic examination (as part of the NARSUM examination) on 30 January 2004, 9 months post-surgery and 5 months prior to separation, the CI stated his left ankle felt quite stable but continued to cause him a significant amount of pain, particularly with running.  He reported no giving way, warmth, redness, or swelling.  Physical examination showed no ankle instability.  ROM measurements were recorded per chart above.  There was no ankle laxity or instability.  The left ankle and lower extremities were neurovascularly intact, aside from numbness of the lateral border of the left foot.  Surgical scars were well healed.  The CI had a very prominent medial malleolus when compared with his right ankle.  

At the 3 May 2004 VA Compensation and Pension (C&P) evaluation, performed 12 months post-surgery and 2 months prior to separation, the CI reported constant swelling, constant ache, shooting pains, and deformity of the left ankle.  The CI claimed to have one incapacitating episode per year which lasted for a day.  Physical examination revealed the CI’s left ankle to appear abnormal with a 7 cm scar around both malleoli.  ROM measurements were recorded per chart above.  ROM was not limited by pain, fatigue, weakness, lack of endurance or incoordination.  A left inversion deformity was noted by the examiner, with the left ankle appearing slightly inverted and outwardly rotated (post-surgery).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle pain condition 10%, coded 5271(ankle, limited motion of).  The VA also rated the left ankle pain condition 10%, coded 5273 (Os calcis or astragalus (talus), malunion of), based on the VA C&P examination 2 months before separation, citing full range of painless ankle motion (20 degrees of dorsiflexion and 45 degrees of plantar flexion) with moderate left inversion deformity.  

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).  Ideal coding would be analogously to 5271 or under code 5273; however, there was insufficient evidence of a marked deformity for any higher rating under code 5273, and no avenue to dual rating of the ankle.  The Board considered alternative VASRD ankle and analogous codes, but all were less applicable or not advantageous to rating any higher than the 10% awarded by the PEB.  

The VA additionally assigned a separate 0% rating for non-painful surgical scar(s).  The Board does not recommend separation rating for scars unless their presence imposes a direct limitation on fitness.  The Board reviewed the STR and did not find evidence that a tender or painful scar separately interfered with duty and therefore a separate rating was not 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 left ankle pain condition.  

BOARD FINDINGS:  In the matter of the left 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 20150603, 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 14 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:

		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)