RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01446
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20020301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Morale, Welfare and Recreation Specialist, medically separated for “left ankle superficial peroneal nerve neuritis,” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions.”  The CI’s 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 - 20020123	VARD - 20030512	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Superficial Peroneal Nerve Neuritis	8622	10%	Postoperative Left Ankle Sprain with Superficial Peroneal Nerve Neuritis	5271-8622	20%	20021113	
Chronic Left Ankle Pain Status Post Brostrom	Cat II					
Possible Neuroma						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Ankle Superficial Peroneal Nerve Neuritis:  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left ankle condition began after an injury that resulted in surgery in April 1998.  Radiographic evaluations (X-rays, MRI and bone scan) in March 2000, and June, July, and August 2001 showed mild inflammation of the mid foot with no evidence of fracture, degenerative joint, bony defects, or ligamentous or capsular abnormalities.  

The 16 July 2001 MEB NARSUM examination, 6 months prior to separation, noted complaints of ankle and lateral pain radiating distally that worsened with all weight bearing activity.  The physical examination showed lateral tenderness, minimal swelling, and no instability.  Dorsiflexion was to 20 degrees (normal) and plantar flexion to 45 degrees (normal).  The 3 October 2001 MEB NARSUM examination, 4 months prior to separation, noted complaints of continuous pain and occasional proximal radiation, with no instability, swelling, or other mechanical symptoms.  The physical examination showed dorsiflexion of 10 degrees and normal plantar flexion with no evidence of painful motion or laxity.  There was a normal hair and sweat pattern, and increased pain with manipulation along the distribution of the superficial peroneal nerve.  The 5 December 2001 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain that worsened after prolonged standing, inability to run, and denied instability.  The physical examination showed an antalgic gait, dorsiflexion of 15 degrees, decreased (4/5) strength, and no evidence of instability.  The sensory and motor examinations were within normal limits.  At the 13 November 2002 VA Compensation and Pension (C&P) evaluation, performed 8 months after separation, the CI reported daily pain with occasional toe dragging, and falls.  He reported once weekly flares lasting 2 hours that resulted in decreased walking during that pain.  The physical examination showed no evidence of tenderness, erythema or swelling.  Normal dorsiflexion and plantar flexion to 40 degrees.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the left ankle neuritis condition, coded 8622 (neuritis, superficial peroneal).  The Navy PEB also listed “chronic left ankle pain status post [surgery]” and “possibly a neuroma” as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from these conditions was properly subsumed under the overall rating for the left ankle neuritis condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated 20% for the left ankle sprain and neuritis condition, analogously coded 5271-8622 (ankle limitation of motion, superficial peroneal neuritis), based on the VA C&P examination 8 months after separation, and citing severe incomplete paralysis of the foot.  

IAW VASRD §4.124a, Diseases Of The Peripheral Nerves, the term “incomplete paralysis” with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve …”   It further states that “when the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree.”  The panel considered the evidence for rating.  Under code 8622 (neuritis of the superficial peroneal nerve), a ‘moderate’ degree of impairment would be rated 10%, while a ‘severe’ degree of impairment would be rated 20%.  Panel consensus was that a fair threshold for the ‘moderate’ rating should entail functionally significant motor and/or sensory impairment encroaching on some occupational tasks.  The December 2001 MEB NARSUM documented an antalgic gait and weakness as a result of the neuritis condition, while the November 2002 VA C&P evaluation documented reports of occasional toe dragging and falls.  The panel agreed that the functional disability in evidence did not support the higher 20% rating for ‘severe incomplete’ paralysis of the superficial peroneal nerve.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left ankle superficial peroneal nerve neuritis condition.  

BOARD FINDINGS:  In the matter of the left ankle superficial peroneal neuritis condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  

In the matter of the contended chronic left ankle pain status post [surgery] and possibly a neuroma conditions, the panel unanimously agrees that it cannot recommend them for additional disability ratings.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150801, 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: 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