RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00100
BRANCH OF SERVICE:  marine corps	SEPARATION DATE:  20040515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Mortarman, medically separated for “degenerative joint disease of the mid foot, right foot” 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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20040218	VARD - 20041102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Joint Disease of the Mid Foot, Right Foot	5299-5003	10%	Degenerative Joint Disease, Right Midfoot	5010-5284	10%	20040806	
Adhesions of the Right Ankle and Mid Foot	Cat II	Post-operative Residuals, Right Ankle Injury	5271	10%		
Ankle Arthralgia, Bilateral						
		Residuals, Left Ankle Injury	5271	0%		
		Scar, Right Ankle	7805	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Degenerative Joint Disease of the Mid Foot, Right Foot.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot condition began in February 1996 after falling down a long hill.  Despite conservative therapy with splints and physical therapy, symptoms persisted and the CI underwent surgical resection of a right calcaneonavicular coalition (band of bony and fibrous tissue) and tightening of the lateral collateral ligaments to stabilize the ankle on 16 October 2001.  Postoperatively, the CI underwent physical therapy.  A note dated 20 April 2002 indicated the CI would return to full duty approximately on 17 June 2002.  

In February 2003 the CI complained of right ankle pain and was seen in the Emergency Room and was treated with crutches, Vicodin (hydrocodone, a narcotic, and acetaminophen, a pain reliever), and ibuprofen (a nonsteroidal anti-inflammatory drug (NSAID)).   Radiographic (X-rays) of the right ankle dated 11 February 2003 were normal.  On 19 February 2003 the CI had more pain distally into his foot after a twisting injury possibly after he had undergone intensive martial arts training.  On examination he had no ankle instability and a negative drawer test.  The operative areas were solid post lateral ligament reconstruction.  There was a bit of swelling without ecchymosis (bleeding under the surface of the skin) present or tenderness along the flexor tendon sheaths.  The examiner’s impression was that there was a contusion issue rather than ligamentous instability.  Magnetic resonance imaging (MRI) dated 20 February 2003 demonstrated no abnormalities of the right ankle and proximal foot. 

The 5 November 2003 MEB NARSUM and NARSUM addendum examinations, 6 months prior to separation, noted complaints of significant frequent sprains and ongoing pain that ranges from 3-7/10 (10 being the worst pain) depending on activity.  Physical examination showed a linear scar of the right ankle.  Range of motion (ROM) of the subtalar joint was 10 degrees of inversion bilaterally and 3 degrees of eversion bilaterally.  There was pain with maximum inversion and eversion, the right greater than the left.  Ankle dorsiflexion was approximately 5 degrees (normal 20) bilaterally and plantar flexion was approximately 55 degrees (normal 45) bilaterally.  Muscle mass and tone were essentially within normal limits.  Muscle strength was 4/5 bilaterally.  There was a minimal anterior drawer sign of the right ankle and pain to palpation over the collateral ankle ligaments and the lateral aspect of the ankle laterally bilaterally with the right being worse than the left.  There was also pain to palpation over the extensor digitorum brevis muscle belly on the right foot which was interposed between the navicular and the calcaneus during the surgical procedure.  There were significant arches bilaterally with weight bearing standing and a minimal rear foot varus was present bilaterally. Non-weight bearing demonstrated minimal forefoot valgus bilaterally. The NARSUM addendum examiner’s diagnoses were arthralgia of the  bilateral ankles, adhesions of the right foot and ankle secondary to corrective surgery, mild rear foot varus, bilateral, mild forefoot valgus, and bilateral, mild pes cavus.  During the 6 November 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported ankle surgery for ankle sprains.  The examiner checked normal for the lower extremities on the clinical evaluation. 

At the 6 August 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported tenderness and joint pain in colder weather.  The CI did not use any crutches for ambulation or stability.  Physical examination showed a residual hyper-pigmented scar 8 cm in length without any adherence to the underlying tissue.  Dorsiflexion bilaterally was 0 to 20 degrees and right ankle plantar flexion was 0 to 40 degrees.  The CI did not complain of any tenderness or fatigue after repeated movements.  Another examination on 6 August 2004 noted left ankle dorsiflexion 0 to 20 degrees and right ankle dorsiflexion 0 to 15 degrees and right ankle plantar flexion 0 to 30 degrees and left ankle flexion 0 to 45 degrees without any decrease in the ROM after repetition and no increase in pain, discomfort or fatigue. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right foot condition 10%, coded 5299-5003 (degenerative arthritis).  The Navy PEB also listed adhesions of the right ankle and mid foot status post-surgery and ankle arthralgia, bilateral as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from these conditions (except the left ankle arthralgia, which was not related to the right ankle condition) were properly subsumed under the overall rating for the right foot IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the right foot condition 10%, coded 5284, (other foot injuries), based on the C&P examination 3 months after separation, citing a moderate foot injury.  

Based on the STR and VA examinations, members determined the left ankle arthralgia was not separately unfitting.  Members discussed whether the CI’s disability at the time of separation rose to the level of a moderately severe or severe condition with use of code 5284.  While preoperatively, the condition was at least moderately severe enough to require surgery; however, 3 months prior to separation there was a minimal anterior drawer sign of the right ankle and pain to palpation over the collateral ankle ligaments and the lateral aspect of the ankle laterally bilaterally with the right being worse than the left.  

At the VA C&P examination, 3 months after separation, the CI walked without ambulatory aids and had a ROM of the right ankle within normal limits.  Therefore, the CI’s condition did not rise to a moderately severe or severe condition proximate to separation.  Furthermore, there was no significant acquired flatfoot (code 5276), claw foot (code 5278), or malunion or nonunion of the tarsal or metatarsal bones (code 5283) nor was there any ankle or subastragalar or tarsal joint ankylosis (codes 5270 and 5272), marked ankle limited motion (code 5271), os calcis or astragalus malunion (code 5273) or had the CI undergone an astragalectomy (code 5274) to warrant a higher rating.  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 degenerative joint disease of the mid foot, right foot condition.  

BOARD FINDINGS:  In the matter of the degenerative joint disease of the mid foot, right foot condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended adhesions of the right ankle and mid foot status post-surgery and ankle arthralgia, bilateral conditions, the panel unanimously recommends no change from the PEB determinations as not separately or independently unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160217, w/attachments
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