RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-00445
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070608

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Hospital Corpsman, medically separated for “status post left ankle Broström for ankle instability” with a disability rating of 10%.

CI CONTENTION: In addition to the left ankle condition, the CI requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 - 20070305	VARD - 20070613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Left Ankle Broström	5299-5003	10%	Post Operative Left Ankle	5271-5019	10%	20060407	
Chronic Ankle Pain to the Left Tibial Talar and Subtalar Joints	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Status Post Left Ankle Broström. According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent left ankle ligament reconstruction in December 2005 with relief of her instability, but not of her chronic pain. An ankle specialist recommended an additional surgery to repair what was thought to be a spastic fracture deformity of the ankle.

At the 7 April 2006 VA Compensation and Pension (C&P) examination, 14 months prior to separation, the CI reported weakness, stiffness, swelling, heat, and redness in the ankle especially on the lateral side where the surgery was, and intermittent pain that traveled up the shin. Physical examination showed limping favoring the left ankle, but there was no edema, effusion, weakness, abnormal movement, guarding or subluxation. Pain was elicited with inversion and eversion. Range of motion (ROM) measurements showed 45 degrees of plantar flexion (normal), and 20 degrees of dorsiflexion (normal). Painful motion was not present, and repetitive use caused no limitation of motion.

During the 26 January 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported intermittent swelling and pain in the left ankle. Physical examination showed limited ROM with inversion. The CI was wearing a soft splint on the left ankle. The MEB NARSUM examination, the same day, noted complaints of chronic ankle pain. Physical examination revealed “good ROM to plantar flexion and dorsiflexion with stiffness to inversion and eversion.” There was tenderness over the sinus tarsi, peroneal tendons and tarsal tunnel, but no evidence of ankle instability.  The left ankle was neurovascularly intact.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 10%, analogously coded 5299-5003 (degenerative arthritis). The PEB also listed chronic ankle pain to the left tibial talar and subtalar joints with possible spastic fracture deformity as a related Category II condition (contributed to the primary unfitting condition). However, any impairment from the Category II condition was properly subsumed under the overall rating for the unfitting left ankle to avoid pyramiding IAW §4.14. The VA also rated the left ankle condition 10%, dual coded 5271-5019 (limited motion of ankle - bursitis), based on the C&P examination, citing painful motion.

There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD diagnostic code for limitation of motion (5271). However there was evidence of painful motion causing functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). 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 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.

2	PD-2017-00445

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY 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 29 Oct 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 of no 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.