RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-00609
BRANCH OF SERVICE:  MARINE cORPS 	SEPARATION DATE:  20040229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Service Marine, medically separated for “subluxating peroneus brevis tendon on the right ankle” with a disability rating of 10%.  

CI CONTENTION:  “Deteriorated ligament in right ankle & progressive back.”  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 - 20040113	VARD - 2040602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Subluxating Peroneus Brevis Tendon on the Right Ankle	5299-5003	10%	Subluxating Peroneus Brevis Tendon, Right Ankle	5271	10%	20040413	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Subluxating Peroneus Brevis Tendon on the Right Ankle.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of multiple ankle sprains prior to enlistment.  In February 2003, he reinjured the right ankle while wrestling and was treated with medications and duty restrictions, but his pain persisted.  Right ankle X-rays on 7 and 21 April 2003 were normal as were stress views on 20 May 2003.  A 5 June 2003 MRI showed signs of a possible ligament tear.  The CI was diagnosed with peroneal subluxation and surgery was recommended, but he declined due to experiences with prior surgical procedures.  
At the 17 August 2003 MEB NARSUM examination, 6 months prior to separation, the CI reported constant pain and that he could sublux (move out of the correct anatomical position) the peroneal brevis tendon at will, which increased his pain.  Physical examination of the right ankle showed mild tenderness along the lateral aspect and a subluxating peroneus brevis tendon, but was otherwise normal.   An 18 September 2003 podiatry addendum explained the proposed surgical procedure and rationale for the CI’s declination.  

At the 13 April 2004 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported wearing a right ankle brace as needed for pain but did not use other assistive devices.  The examiner noted no acute distress and no right ankle redness or heat.  In physical therapy the same day, range of motion (ROM) measurements showed 55 degrees (normal 45) of plantar flexion and 10 degrees (normal 20) of dorsiflexion, both after 10 repetitions, which increased pain.  The CI had slight right ankle guarding but no abnormal shoe wear patterns.  Gait was not recorded.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, coded 5299-5003 (degenerative arthritis).  The VA rated the right ankle condition 10%, coded 5271 (limited motion of the ankle), citing moderate limited ankle motion.  Members agreed that the CI’s limitation of dorsiflexion as well as painful motion (IAW §4.59) supported a 10% rating under VASRD code 5271.  The panel considered alternative VASRD ankle and analogous codes, but none were advantageous to 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 right ankle condition.  

BOARD FINDINGS:  In the matter of the subluxating peroneus brevis tendon of the right ankle 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 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 20160912, 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 USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
	XXXXXXXXXXXXXXXXXXX  					
         Acting