RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02492
BRANCH OF SERVICE:  nAVY 	SEPARATION DATE:  20080313

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Master at Arms, medically separated for “chronic pain and stiffness, bilateral ankles,” with the left and right ankle separately rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI requests medical retirement.  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 - 20071219	VARD - 20080716	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain and Stiffness, Right Ankle	5099-5020	10%	Residuals Sprain Right Ankle with Muscle Weakness and Scars	5271	10%	20080324	
Chronic Pain and Stiffness, Left Ankle	5099-5020	10%	Residuals Sprain Right Ankle with Muscle Weakness and Scars	5271	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Pain and Stiffness, Bilateral Ankles.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained multiple sprains of each ankle and required surgical intervention for each.  He underwent left ankle surgery in January 2001 to repair for a ligament repair, an osteophyte excision in December 2006 and a follow-on arthroscopy in September 2007.  Surgery on the right ankle occurred in June 2006 for a ligament repair and again in May 2007 for a spur excision.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty and the CI was referred for an MEB.  

The MEB NARSUM on 2 November 2007, 4 months prior to separation and after the final surgery, noted the CI experienced bilateral ankle stiffness and pain with running and prolonged standing.  The physical examination noted a limited range of motion (ROM) which is charted below.  Both ankles showed tenderness to palpation.  Motion was painful on the left (which had surgery in September).  The ankles were stable with normal strength.  Swelling was absent and the surgical wounds were well healed.  No comment was made on the gait.  

At the VA Compensation and Pension (C&P) foot examination performed on 24 March 2008, 11 days after separation, the CI conveyed he was unable to stand for more than a few minutes and could not walk a mile or more, but also stated that he had no limitations to walking and did not use an assistive device.  The panel could not explain this inconsistency.  The examination showed the CI walked with an abnormal gait and had tenderness over the ankles.  There was not instability or weakness.  The ROM is charted below.  Painful motion present in both ankles.  There was no further limitation with repetition.  The general C&P examination was accomplished a few weeks later on 9 April 2008.  It noted a normal gait.  

In physical therapy on 24 April 2008 the CI was noted to be “ambulating well.”  One week later in physical therapy he was noted to have a normal gait.  

A subsequent C&P “joints” evaluation on 18 December 2008, 9 months post-separation, noted ongoing ankle pain.  The CI worked part time as a carpet cleaner with less than 1 week lost time due to his ankle pain over the last year.  He denied incapacitation, but reported that he was unable to stand for more than a few minutes or walk greater than a quarter of a mile.  He did not use an assistive device.  The physical examination showed no evidence of abnormal weight bearing, instability, or weakness in either ankle.  The ROM is charted below.  Motion was pain free.  There was no further limitation with repetition.  The CI walked with a normal gait.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left ankle conditions 10% each, for a combined 20%, each coded 5099-5020 (analogous to synovitis).  The VA also rated the right and left ankle conditions 10% each, both coded 5271 (limited motion of the ankle), citing moderate limited motion for both ankles.  The panel considered if the limitation of motion was moderate or marked when considered under 5271, limitation of ankle motion.  All panel members agreed the limitation of motion was no more than moderate in the examinations most proximate to separation and remote from the surgery.  The panel noted that the majority of evaluations proximate to separation documented a normal gait.  A higher rating of 20% was not indicated in the absence of marked limited ROM of the ankles.  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 chronic pain and stiffness, bilateral ankles condition.   

BOARD FINDINGS:  In the matter of the chronic pain and stiffness, bilateral ankles condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20151023, 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:

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

		
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	     				  Acting