RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01014
BRANCH OF SERVICE:  navy	SEPARATION DATE:  20040709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Submarine Radio Direction Finding Set Maintenance Technician, medically separated for “right ankle post-traumatic degenerative changes and residual pain” with a disability rating of 10%.

CI CONTENTION:  Review all conditions.  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 - 20040405	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Post-Traumatic Degenerative Changes and Residual Pain	5299-5003	10%	No VA Examination Proximate to Separation in Evidence	
Right Tibia/Fibula Fracture	Cat II		
Right Ankle Dislocation	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Right Ankle Post-Traumatic Degenerative Changes and Residual Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent an open reduction internal fixation in June 2002 after dislocating the right ankle and fracturing the right tibia and fibula.  A post-surgical CT scan revealed no significant difference in the distance between the distal (bottom) tibia and fibula with no evidence of syndesmotic instability (ankle ligaments appropriately binding the tibia and fibula).  X-rays showed a stable right ankle with post-operative degenerative changes.  
At the 4 December 2003 MEB orthopedic evaluation, 7 months before separation, the CI reported right ankle pain.  Physical examination showed right ankle tenderness with sensation grossly intact.  Plantar flexion, dorsiflexion and posterior tibial (rear-Achilles) strength was 5/5, but perineal ankle (outer-lateral side) strength was decreased to 4/5.  Goniometric-measured range of motion (ROM) was dorsiflexion to -15 degrees (normal 20) and plantar flexion was 10 degrees (normal 45).  Painful motion was not addressed, but the CI’s right leg heel raise was noted to be considerably painful.  Gait was not addressed.

During the 30 December 2003 MEB NARSUM examination, 6 months prior to separation, the CI reported persistent right ankle pain with inversion, and morning stiffness and pain.  Physical examination did not address the gait.  Right ankle dorsiflexion and plantar flexion were recorded as “good,” but there was painful motion.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ankle condition 10%, analogously coded 5003 (degenerative arthritis).  Additionally, the PEB listed the right tibia/fibula fracture and right ankle dislocation as related diagnoses (Category II) that contributed to the disability.  The panel agreed that the right tibia/fibula fracture and right ankle dislocation were not separate conditions which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The panel agreed that the MEB orthopedic evaluation along with multiple other STR examinations were consistent with “moderate” limitation of motion required for the 10% rating under code 5271.  The preponderance of evidence did not indicate an abnormal gait which caused functional loss that would impact functioning in the average civil occupation.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to rating.  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 right ankle condition.

BOARD FINDINGS:  In the matter 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.  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 20160915, w/atchs
Exhibit B.  Service 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

	
XXXXXXXXXXXXXXXXXX	  
Acting