RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01823
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20020815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “status post open repair osteochondral lesion, right talus,” with a disability rating of 10%

CI CONTENTION:  The CI made no specific contention.  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 - 20020624	VARD - 20020918	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Right Talus	5271	10%	Synovitis, Right Ankle, Postoperative	5024	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Talus/Ankle.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right ankle condition began in August 2001 after stepping in a hole.  An arthroscopic debridement of the right ankle was performed on 07 February 2002 which diagnosed right ankle synovitis and osteochondral lesion.  Despite treatment, the CI’s condition could not be adequately rehabilitated to satisfactorily achieve military occupational specialty performance.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 26 March 2002, 1 month after surgery, the physical examination showed decreased range of motion (ROM) of dorsiflexion 5 degrees (normal 20 degrees) and plantar flexion to 5 degrees (normal 45 degrees) with painful motion.  
The MEB NARSUM examination on 20 May 2002, 3 months prior to separation, noted complaints of significant right ankle pain and edema exacerbated by running, impact exercises, and prolonged standing.  Physical examination revealed no edema, ecchymosis (skin discoloration), tenderness or visible or palpable deformities.  The neuromuscular examination was normal (motor strength, deep tendon reflexes, sensation, and muscle tone).  The ROM was dorsiflexion to 5 degrees (normal 20 degrees) and plantar flexion to 20 degrees (normal 45 degrees) with painful motion.  At podiatry examination on 24 June 2002, 2 months before separation, the physical examination revealed mild right foot and ankle edema, Achilles tendon tenderness, sinus tarsi and peroneal pain.  She was noted to have a hypermobile foot (joints move more than normal ROM), ankle ROM was not addressed.  She was accessed to have synovitis, capsulitis, hypermobile foot, peroneal tendonitis and Achilles tendonitis.   A VA Compensation and Pension examination was not performed and the CI’s STR was utilized for rating purposes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5271 (ankle, limitation of motion).  The VA also the rated the right ankle condition 10% 5024 (tenosynovitis), based on the CI’s STR.  The panel deliberated on the probative value of the MEB (DD Form 2808) examination and MEB NARSUM ROM examinations.  The panel adjudged 5 degrees plantar flexion (marked limitation of motion) documented by DD Form 2808 was not consistent with the preponderance of post-operative STR which was indicative of the MEB NARSUM’s (moderate) plantar flexion to 20 degrees.  Therefore, the panel agreed there was no limitation of dorsiflexion or plantar flexion that supported a higher rating under the VASRD diagnostic code for limitation of motion (5271).  However there was sufficient evidence of painful motion causing functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45).  There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints, no malunion of the os calcis (calcaneus) or astragalus (talus) or astragalectomy for consideration under the respective diagnostic codes (5270, 5272, 5273 or 5274).  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 right ankle condition.

BOARD FINDINGS:  In the matter of the status post open repair osteochondral lesion, right talus condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification to 20% and did not elect to submit a minority opinion.  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 20150618, 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

      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

	
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