RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01547
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20040515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aircraft Communication Systems Technician, medically separated for “left ankle pain” with a disability rating of 20%.  

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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040324	VARD - 20040928	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain and Instability of Left Ankle Status Post Multiple Surgeries	5099-5003	20%	Postoperative Residual, Left Ankle Injury	5271	10%	20040806	
Chronic Intermittent Right Shoulder 	Not Unfitting/
CAT III	Residual, Right Shoulder Separation (Dominant)	5299-5203	10%	20040806	
Pain Alcohol Dependent in Remission	Not Unfitting/
CAT III					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Pain and Instability of Left Ankle Status Post Multiple Surgeries.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left ankle in 1999 jumping off a wall.  He underwent two left ankle arthroscopies surgeries (April 2002 for left ankle arthroscopic shaving of spur and May 2003 for arthroscopic debridement of a scar, loose joint bodies, and spur).  An MRI dated 7 March 2003 demonstrated talar beaking and osteophytes in the left ankle, improved from a previous MRI.  He continued to have significant loose joint bodies, as well as extensive scar tissue and re-growth of the talar spur. His left ankle condition was diagnosed as a chronic problem, and although his ankle was “technically stable,” the CI would continue to experience pain and degeneration of the joint.  The CI was directed to not participate in running or jumping sports, including military fitness training and referred to the PEB.  

The 9 July 2003 Orthopedic Clinic memo, 2 months post-surgery and 10 months prior to separation, stated the CI had continued significant loose joint bodies, extensive scar tissue in and about the ankle, and continued regrowth of the spur.  The surgeon opined the CI’s condition would be a chronic problem and had no options for further treatment.  The ankle was stable (i.e., it was not instability causing the spurs) and he had degenerative changes producing loose joint bodies.  The surgeon felt the CI should not participate in any running or jumping sports.  

The 3 November 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of chronic left ankle pain and instability.  Physical examination showed left foot ankle laxity and pain with inversion, otherwise normal range of motion (ROM) in all extremities, and normal (5/5) strength.  Neurologic examination was non-focal and there was normal balance and gait.  

During the 17 March 2004 visit to the Manipulation Medicine Clinic, 2 months prior to separation, the examiner reported the CI had a severe restriction of the talus and the mid tarsal arch of the left foot and his gait was slightly abnormal.  The CI was reluctant to dorsiflexion of the left ankle and could not perform heel-toeing correctly.  The CI responded well to manipulation treatment and noticed immediate improvement and was able to walk without pain.  At the 31 March 2004 Primary Care Clinic visit, 2 months prior to separation, the CI reported left ankle pain.  X-Rays showed a bone cyst of the left ankle.  There was mild restriction to the left talus.  

At the 6 August 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported his left foot and ankle pain was much better since surgery.  He did not complain of ankle instability and his foot pain was much improved.  He did have intermittent foot and ankle pain and had difficulty going up and down stairs and took pain medicine when his foot hurt.  He limped and occasionally used a cane or a brace when he was going to have to stand for a long time and would sit down after 20 minutes of standing.  The CI could walk about one mile and then had ankle and foot pain.  Some days he was completely pain free and the foot and ankle did not limit or affect his daily activities.  Physical examination of the left ankle and foot showed a well healed lateral scar, which was movable and non-tender.  There was tenderness to palpation anteriorly over the mortise of the ankle anterior to the medial malleolus.  ROM was dorsiflexion 5 degrees, plantar flexion 60 degrees, inversion 30 degrees and eversion 20 degrees; “this was the identical motion on the right side also.”  The CI complained of a stretching like sensation, discomfort, with maximum dorsiflexion of the ankle but was completely pain free during ROM measurements.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 20%, coded 5099-5003 (arthritis, degenerative), citing pain and instability.  The VA rated the left ankle condition 10%, coded 5271, (ankle, limited motion), based on the C&P examination 3 months after separation, citing painful motion of a major joint.  The PEB 20% rating is the same as the maximum VASRD ankle rating under code 5271.  The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to rating.  Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a 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 condition.  

Contended PEB Conditions:  Alcohol Dependent in Remission and Chronic Intermittent Right Shoulder Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Alcohol dependence in remission is not a medical disability condition IAW DOD Instructions, and is not ratable.  The chronic intermittent right shoulder pain condition was noted in the 3 December 2002 LIMDU (acromioclavicular (AC) separation), implicated in the NMA statement (non-medical assessment), and forwarded to the PEB on NAVMED 6100/1.  The right-handed CI injured his right shoulder on 26 October 2002 due to a fall.  Initial X-rays were negative and he was diagnosed with an AC separation.  The shoulder improved with physical therapy, but the CI continued to have intermittent pain.  

The NARSUM did not provide an examination of the right shoulder.  The 5 September 2003 MEB examination noted right shoulder pain with history of dislocation and AC separation with release from civilian rehabilitation in March 2003; however, he still experienced occasional pain with limited movement and lack of strength in comparison to his left shoulder during resistance workout.  Examination documented only a shoulder scar.  A 17 March 2004 specialist evaluation, 2 months prior to separation, was summarized by the physician as having no further treatment available for the CI’s classic dislocation with tear of the anterior inferior aspect of the capsule.  He advised the CI he would probably dislocate the shoulder again at some point in the future and then he should have a laparoscopic repair.  

There was performance-based evidence in the NMA conforming the shoulder condition separately interfered with the CI’s ability to do a partial PFT.  Given the CI had yet to have recurrent shoulder dislocations or separations, and surgery was likely corrective if there were any repeated shoulder dislocations or separations, there was not a preponderance of the evidence that the right shoulder condition was separately unfitting.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left ankle pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended alcohol dependent in remission and chronic intermittent right shoulder pain conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration. The panel 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 20161018, 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 USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC

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