RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00795
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20040615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Fireman, medically separated for “left ankle instability” with a disability rating of 20%.  

CI CONTENTION:  No specific contention was made.  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 - 20040331	VARD - 20041116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Instability	5099-5003	20%	S/P Broström Ankle Ligament Reconstruction, Left Ankle	5299-5271	20%	STR	
Failed Broström Repair	Cat II					
Possible RSD	Cat II					
Status Post (S/P) Broström Ankle Ligament Reconstruction	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Ankle Instability.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sprained his left ankle condition on 29 October 2001.  Despite physical therapy, duty limitations and medications, the CI had persistent symptoms.  An MRI showed a possible ankle bone fracture.  The CI underwent a diagnostic arthroscopy and a Broström repair for instability on 1 April 2003.  Following a period of rehabilitation, he remained symptomatic and underwent revision surgery on 4 September 2003.  Despite rehabilitation and limited duty (LIMDU), the CI remained symptomatic and was considered for a second LIMDU period.  

The 26 November 2003 MEB NARSUM examination, 7 months prior to separation, noted the CI was experiencing significant left ankle pain with motion.  The left ankle range of motion (ROM) had severely-limited dorsiflexion to “approximately neutral” or 0 degrees (normal 20) and plantar flexion was 20 degrees (normal 45).  The prior laxity had been repaired.  There was an abnormal increase in sensitivity and some mild hyperemia (excess of blood in the vessels supplying the part of the body affected).  The examiner noted the CI may have had symptoms of early reflex sympathetic dystrophy, or RSD, a neurological disorder.  This examination was the CI’s final LIMDU evaluation, however the examiner recommended an additional 8-month shore LIMDU period.  A return to full duty status was anticipated after this additional LIMDU.  

In physical therapy on 5 January 2004 the CI had an antalgic gait due to pain and limited ROM of dorsiflexion to 0 degrees neutral position and 30 degrees plantar flexion.  One month later in orthopedics, the CI was noted to have a stable ankle with improved ROM at 5 degrees dorsiflexion and 15 degrees plantar flexion.  Eleven days later in physical therapy, the CI was noted to have a ROM of dorsiflexion to 0 degrees and 40 degrees plantar flexion.  Tenderness was present and the gait remained antalgic.  The 15 March 2004 orthopedics examination noted decreased left ankle pain.  The CI’s left ankle ROM was 0 degrees dorsiflexion and 60 degrees extension (plantar flexion), which the examiner noted as a gradual improvement.  The CI received a left ankle injection which provided immediate, complete pain relief.  In physical therapy on 18 March 2004 the CI was noted to have full left ankle ROM and a normal but painful gait; there was no swelling.  No comment was made on stability.  The examiner opined that treatment goals were being met.  There was no VA Compensation and Pension examination proximate to separation in the evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 20%, analogously coded 5099-5003 (arthritis, degenerative).  The Navy PEB also listed “failed Broström repair,” “possible RSD,” and “S/P Broström ankle ligament reconstruction on 1 April 2003” as related Category II conditions (contributing to the unfitting condition).  The impairment from the failed Broström repair and S/P Broström ankle ligament reconstruction conditions was properly subsumed under the overall left ankle rating IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The possible RSD condition was not actually diagnosed, but remained a possible condition to explain the symptoms of pain and redness found on examination.  The panel observed no comment was made regarding this RSD condition in the final clinical notes in evidence.  The VA also rated the left ankle condition 20%, analogously coded 5299-5271 (limited motion of the ankle), based on a partial STR, citing pain, instability and marked limitation of motion.

The panel noted the PEB assigned the maximum rating (20%) available under the diagnostic code 5271.  The panel considered codes 5262 (tibia and fibula impairment) and 5284 (foot injuries, other), but found no higher rating than that adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left ankle instability condition.  

BOARD FINDINGS:  In the matter of the left ankle instability 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.  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 20160916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Rating 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 USN
- XXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXX, former USN
- 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 USN