RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00155
BRANCH OF SERVICE:  marine corps 	SEPARATION DATE:  20060915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Reconnaissance Man, medically separated for “left ankle instability” and “radiocarpal joint arthritis, left wrist,” each rated 10%, with a combined disability rating of 20%. 

CI CONTENTION:  The CI contends he sustained other injuries not considered by the service.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060608	VARD - 20070530	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Instability 	5271	10%	Left Ankle Osteoarthritis	5003-5271	20%	20070208	
Left Wrist Radiocarpal Joint Arthritis	5215	10%	Left Wrist (minor)	5003	10%	20070208	
Lumbar and Cervical Degenerative Changes	Cat  III	Osteoarthritis, Lumbar Spine	5003	10%	20070208	
		Osteoarthritis, Cervical  Spine	5010	10%	20070208	
Bilateral Knee Pain	Cat III	Osteoarthritis, Right Knee	5003	10%	20070208	
		Osteoarthritis, Left Knee	5003	10%	20070208	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Ankle Instability.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI fractured his left ankle secondary to a parachute landing in April 2004.  Despite fracture healing, the CI developed significant instability of the ankle joint and subsequently underwent ligament stabilization surgery in September 2005.  

At the 3 March 2006 MEB NARSUM examination, 6 months prior to separation, the CI endorsed left ankle pain upon ambulation and the inability to run.  The examiner documented that the CI currently used an ankle stabilizing orthotic (ankle brace) for all activities.  His physical examination (PE) revealed consistent findings of ankle instability specifically noting a positive and painful “drawer” test (excessive front and back motion of the ankle).  Left ankle range of motion (ROM) was measured at 10 degrees dorsiflexion (normal 20) and 40 degrees plantar flexion (normal 45).  At the 8 February 2007 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI’s PE revealed tenderness about the left ankle with a ROM of 10 degrees dorsiflexion and 30 degrees of plantar flexion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle instability condition at 10%, coded 5271 (limited motion of the ankle) whereas, the VA rated the left ankle condition at 20%, dual coded 5003-5271, (arthritis, degenerative-limited motion), based upon the C&P examination 5 months after separation, citing marked limited motion of the ankle.  Absent evidence of joint ankylosis or bony malunion with resultant deformity, all panel members agreed that the limitation of motion code of 5271 as utilized by the PEB was most appropriate in this clinical case.  Members further agreed that the overall and consistent amount of joint limitation both pre and post separation would support no greater than a “moderate” impairment and thus consistent the PEB’s current 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 left ankle condition.  

Left Wrist Radiocarpal Joint Arthritis.  According to the STR and the MEB NARSUM, the CI’s left (non-dominant) wrist condition began in January 2003 after falling on his outstretched arm while running.  X-rays of the left wrist performed on 3 June 2005 demonstrated evidence of degenerative joint disease and an MRI indicated surrounding joint fluid which “…may reflect a mild sprain”.  

At the 6-month pre-separation NARSUM examination, the CI endorsed having “pain to his wrist”.  His PE revealed decreased left wrist ROM of 60 degrees dorsiflexion (normal 70 degrees) and 70 degrees palmar flexion (normal 80).  There was no comment with regards to painful motion.  
At the 5-month post-separation C&P evaluation, the CI reported intermittent pain about the little finger side of his left wrist.  “In general, it [left wrist symptoms] does not prevent him from undertaking all the activities of daily living.”  His PE revealed normal dorsiflexion and minimal decrease in palmer flexion of the left wrist to 70 degrees.  There was no comment in regards to painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left wrist condition 10%, coded 5215 (wrist, limitation of motion).  The VA also rated the left wrist condition 10%, coded 5003, (arthritis, degenerative), based on the C&P examination 5 months after separation, citing painful or limited motion of a major joint or group of minor joints.  Panel members agreed that in the absence of joint ankyloses, the maximum rating for any sort of limited motion of the wrist is 10%, and thus equivalent to the PEB’s current 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’s adjudication for the left wrist condition.  

Contended PEB Conditions:  Degenerative Changes of the Lumbar Spine and Bilateral Knee Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The NARSUM noted a long history of chronic back pain and bilateral knee pain.  A lumbar spine MRI on 15 March 2004 revealed a central protrusion with annular tear at L5-S1 without stenosis or nerve-exiting narrowing.  At a chiropractor appointment on 31 January 2006 the CI reported increased back pain during weight lifting.  Tenderness to palpation was recorded and the CI’s posture was normal.  The CI underwent an arthroscopic debridement of his right knee on 14 July 2000 and was able to return to full duty.  Bilateral knee X-rays on 3 June 2005 showed no evidence of fracture, dislocation or joint effusion.  There was no obvious joint space narrowing or evidence of osteoarthritis in either knee.  At the 10 March 2006 PT appointment the CI only complained of left knee pain but reported his knee was doing a lot better since his injury during combat training.  Bilateral knee ROM was 0-120 degrees (0-140 normal) without pain. None of the above conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at or near the time of separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left ankle condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the left wrist condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended degenerative changes of the lumbar spine and bilateral knee pain conditions, the panel unanimously recommends no change from the PEB determination as not being separately unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20160316, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

					XXXXXXXXXXXXXXXXXX
	     				Acting