RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXX	CASE: PD-2016-01788
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20040331

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Culinary Specialist, medically separated for “left ankle pain” with a disability rating of 10%.

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 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 – 20031017	VARD - 20041101	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteochondral Defect, Left Ankle, Large...	5299-5003	10%	Degenerative Arthritis, Left Ankle-Claimed as Avascular Necrosis	
5299-5271	
10%	
20040428	
Posttraumatic Degenerative Changes, Left Ankle	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Left Ankle Osteochondral Defect. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in December 2002 while walking. He began having global ankle pain and was cared for by a civilian physician who injected his ankle on two occasions. The April 2003 left ankle MRI showed abnormal marrow signal within the talar dome that was consistent with osteonecrosis and a small effusion.

The 18 July 2003 MEB NARSUM examination, 8 months prior to separation, noted complaints of left ankle pain with prolonged standing and gradual loss of motion. The CI reported that he was unable to run due to pain. On examination left ankle range of motion (ROM) showed dorsiflexion of 10 degrees (normal 20) and plantar flexion of 30 degrees (normal 45). There was mild effusion (fluid in the joint). There was no pain with motion noted and the left ankle appeared stable on stress testing. During the 7 August 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported left ankle problems. Physical examination revealed dorsiflexion of 10 degrees, plantar flexion of 5 degrees, eversion of 5 degrees, and inversion of 15 degrees.

At the 28 April 2004 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported 8/10 left ankle pain with activity. He could not stand too long and it bothered him whenever he was working. Physical examination of the left ankle revealed two well-healed scars. Left ankle ROM measured in degrees showed dorsiflexion to 15, plantar flexion 8, eversion 10, and inversion 8.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 10%, analogously coded 5003 (degenerative arthritis) in accordance with the Veterans Administration Schedule for Rating Disabilities. The Navy PEB’s Category II diagnosis of left ankle post-traumatic degenerative changes is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed under the same rating. The VA also rated the left ankle condition 10%, analogously coded 5271 (ankle, limited motion), based on the C&P examination, citing moderate limited motion of the ankle.

Panel members agreed the limitation of motion was no more than “moderate” therefore supporting the 10% rating adjudicated by the PEB. A higher rating of 20% was not indicated in the absence of “marked” limited ROM of the ankle. Because there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 10% rating adjudicated by the PEB. After due deliberation, considering all 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 condition and IAW VASRD §4.71a, the panel 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 20161121, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

2	PD-2016-01788

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVf COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO:
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 22 Mar 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

Copy to:
PDBR