RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01391
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20050123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Safety Technician, medically separated for “left ankle joint traumatic arthropathy” with a disability rating of 10%.   

CI CONTENTION:  “VA rating for ankle injury equals 20%, associated nerve damage in ankle/foot rated 10% by VA.”  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 - 20040811	VARD - 20050315	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle Joint Traumatic Arthropathy	5299-5003	10%	Residual, Left Ankle Fractures	5271	20%	20041206	
Left Subtalar Joint Traumatic Arthropathy	Cat II					
Distal Left Tibial Motor Neuropathy	Cat II	Neuritis, Left Foot Associated with Residual, Left Ankle	8621	10%	20041206	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Left Ankle Joint Traumatic Arthropathy.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgical repair of a fractured left tibia with the installation of a plate and three screws in December 2003.  Conservative treatment followed; however, pain and functional limitations continued.

The 21 June 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of pain, giving way, stiffness, clicking, and limping.  He continued to have pain and numbness to the dorsum of the foot.  Pain was reported on rest and was aggravated by standing, walking, running, changes in direction, jumping, hard stop, and going down stairs and ramps.  The examiner noted the CI had continued to work full duty.  

During the 29 June 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported chronic left ankle pain and numbness and tingling in his left foot.  Physical examination showed left ankle decreased flexion due to pain.  No laxity or deformity was noted.  Tenderness was present around the lateral malleolus.  There was full range of motion (ROM) in the digits of the left foot.

At the 6 December 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported constant pain with flare-ups once a week, lasting 2 days , causing increased difficulty with walking and standing.  The CI used a cane to stabilize himself, but could ambulate without it.  Physical examination showed a normal appearing lower extremity with no swelling, and ankles were normal bilaterally.  ROM showed dorsiflexion of 15 degrees and plantar flexion of 40 degrees and was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination.  No ankle deformity or ankyloses were present and gait and posture were normal.  Motor and sensory function were normal with the exception of decreased sensation in light touch in the dorsal aspect of the left foot over the first metatarsal area.  Reflexes were intact.  X-rays taken that day revealed “very mild degree of degeneration” of the left ankle.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5299-5003 (analogous to arthritis, degenerative).  The PEB also listed “distal left tibial motor neuropathy” and “left subtalar joint traumatic arthropathy” as related Category II conditions that contributed to the primary unfitting condition but were not separately unfitting.  The panel noted the absence of evidence supporting a separately unfitting nerve condition.  Although the CI complained of numbness and tingling, there was no documentation of ankle/foot atrophy, motor weakness, or incoordination.  Panel members agreed the impairment from the distal left tibial motor neuropathy and left subtalar joint traumatic arthropathy were properly subsumed under the overall rating for the ”left ankle joint traumatic arthropathy” category I condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the left ankle condition 20%, coded 5271 (ankle, limited motion), based on the C&P examination 1 month before separation, citing moderate limited motion of the left ankle (warranting a 10% rating) and granting an additional 10% “due to additional disability manifested by limitation of motion, or restriction of activity, or functional impairment caused by pain during periods of flare-up, or when the body part is used repeatedly over a period of time.”  

The panel agreed a 10% rating under the VASRD diagnostic code for limitation of motion (5271) was warranted based on the ROM recorded at both the PT and C&P exams.  A 10% rating is also supported based on functional loss (§4.40 and §4.45) due to painful motion (§4.59), under the PEB coding scheme, and therefore, a change in coding is of no benefit to the CI.  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 condition.    

BOARD FINDINGS:  In the matter of the left ankle joint traumatic arthropathy 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 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 20161004, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN