RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2017-01007
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20050607

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Storekeeper, medically separated for “left posterior tibial tendon dysfunction [left ankle pain]” with a disability rating of 10%.

CI CONTENTION:  “Left foot and ankle unable to put pressure for long period of time.”  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 - 20050404	VARD - 20060424	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Posterior Tibial Tendon Dysfunction	5271	10%	Left Foot and Ankle Arthralgia	5271	10%	20051105	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Posterior Tibial Tendon Dysfunction  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left ankle condition began in July 2003 after he fell down a ladder sustaining a left ankle injury diagnosed as an avulsion fracture/deltoid ligament injury (medial malleolus).  The CI developed instability, deltoid insufficiency, and a progressive flat foot deformity.  On 6 December 2003, he underwent a left flat foot reconstruction (left posterior tibial tendon reconstruction with flexor digitorum longus transfer) and calcaneal (heel) osteotomy.  An orthopedic examination on 22 November 2004 noted good ankle motion and some tenderness at the heel screw sites.  Hardware was removed on 1 December 2004 due to heel pain.  

The 2 December 2004 MEB NARSUM examination, 6 months prior to separation, noted left foot and ankle pain with the inability to stand more than 10 minutes or ambulate faster than a walk.  Physical examination showed left heel tenderness, no laxity or instability, and intact sensation.  The foot was warm with good capillary refill.  X-ray results demonstrated the heel surgery healed and the talus had a normal tilt.

At the 5 November 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported daily left ankle pain increased with weight bearing and the inability to run or perform heavy lifting.  Physical examination revealed a normal gait.  There was mild left foot tenderness at the sole, no swelling or bony abnormalities noted, and a post-surgical scar healed.  Dorsiflexion was 10 degrees (normal 20) and plantar flexion 45 degrees (normal).  No decreased range of motion (ROM) due to pain, weakness, fatigability or incoordination after repetition.  Foot strength was “fairly good” at 4/5 and sensation intact.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left ankle condition 10%, coded 5271 (ankle, limited motion) citing pain.  The VA also rated the condition 10%, using the same code (5271), based on the C&P examination, citing “moderate” ankle limited motion.  The panel agreed that the STR and VA ROM examinations proximate to separation were consistent with “moderate” ankle limitation of motion to support a 10% rating under code 5271.  There was no ankylosis (5270), or nonunion or malunion (5262) to support a higher rating.  The panel also considered a rating under code 5284 (other foot injuries), but agreed that the CI’s impairment did not approximate “moderate severe” to support a 20% 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.

JAN 1 5 2019
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  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: