RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00237
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20060115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantry Assault Man, medically separated for “right ankle pain” with a disability rating of 10%.  

CI CONTENTION:  “Right ankle pain from service connected injury has increasingly grown worse and is chronic…”  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 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 - 20051117	VARD - 20060829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain	5299-5003	10%	Residuals, Right Ankle Sprain	5271	10%	20060518	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Right Ankle Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a severe right ankle sprain in 2004.  The CI underwent a right ankle arthroscopy in July 2005 with debridement of synovitis.  At the time of the surgery the ankle was determined to be stable.  

The 3 November 2005 MEB NARSUM, 3 months prior to separation, noted complaints of right ankle pain with walking, standing greater than half an hour, and inability to run.  The physical examination noted ankle tenderness without effusion and there was no evidence of nerve entrapment (negative Tinel’s sign).  The ankle range of motion (ROM) was dorsiflexion of 10 degrees (normal 20) and a plantar flexion of 35 degrees (normal 45).  The subtalar motion was normal without pain, there was normal strength, normal sensation, and no ankle effusion.  There was marked tenderness in the anterolateral aspect of the right ankle without a Tinel’s sign.    

At the 18 May 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant ankle pain, rated 4-6/10, stiffness, instability, and weakness.  He wore a brace for support so “the ankle does roll when walking on uneven ground.”  The CI also reported that he is “unable to run as the ankle swells shortly after this and is sore for several days” and that he is able to stand all day but it is painful.  The physical examination showed a normal gait.  There was evidence of pain and swelling.  The CI was unable to heel or toe walk due to right ankle pain.  Ankle ROM was normal dorsiflexion and plantar flexion 25 degrees and there was no additional loss of motion with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5003 (arthritis, degenerative).  The VA also rated the right ankle condition 10%, coded 5271 (limited motion of the ankle) citing moderate limited motion of the ankle with pain.  The Navy PEB’s related Category 2 diagnosis of “status post arthroscopic synovectomy” is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed under the same rating.  

The PEB assigned a 10% rating for the ankle condition, therefore the panel reviewed to see if a higher rating was supported with any applicable VASRD code.  There was no limitation of motion that supported a higher rating under 5271 for “marked” limitation of motion.  The panel considered alternative VASRD ankle codes, but all were less applicable.  The panel also considered whether the VASRD foot code for other foot injuries (5284) provided for a higher rating (§4.7).  However, all panel members agreed that the impairment was not appropriately characterized as “moderately severe” to support the next higher 20% rating under this code.  There was therefore no higher than a 10% rating available with any alternative VASRD code.  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.  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 right ankle pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20160416, 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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