RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-03127 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20071215

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Field Artillery Operations Chief, medically separated for “left ankle osteoarthritis” with a disability rating of 20%.

CI CONTENTION: In addition to the left ankle, the CI also requested review of other conditions 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 - 20070515	VARD - 20080303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis, Left Ankle	5299-5262	20%	S/P Left Ankle Surgery with Residual Tendinitis, Strain and Instability	
5099-5024	
10%	
20070726	
Pain, Left Ankle	Cat II					
Mild [Left] Ankle Instability	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	
	
ANALYSIS SUMMARY:

Left Ankle Osteoarthritis. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left ankle surgery (Brostrom) in January 2006 for lateral ankle stabilization. The physical therapy examination on 4 December 2006 noted the CI ambulated with ankle inverted at terminal stance causing pain at the distal fibula and anterior tibia/fibula joint. Left ankle range of motion (ROM) testing showed dorsiflexion of 0 degrees (normal 20) and plantar flexion of 65 degrees (normal 45).  Strength was 5-/5 for plantar flexion and eversion.

The 3 April 2007 MEB NARSUM examination, 8 months prior to separation, noted complaints of chronic left ankle pain and instability. Physical examination showed normal strength and ROM; however, there was discomfort, mild crepitus and painful motion. Provocative testing showed right greater than left ankle laxity. X-rays revealed degenerative joint disease with small osseous fragments posterior to the left talus.

At the 26 July 2007 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported an unstable left ankle that still “rolled.” Physical examination showed a normal gait, but there was left ankle inversion laxity and tenderness just below the lateral malleolus. Left ankle ROM testing showed dorsiflexion of 20 degrees and plantar flexion of 45 degrees with pain at the extremes of motion. There was no additional limitation due to pain, fatigue, weakness, lack of endurance or incoordination after repetitive use or during flare-ups. Strength and reflexes were normal. X-rays were normal with the exception of a small plantar calcaneal spur.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 20%, analogously coded 5299-5262 (tibia and fibula, impairment of). The PEB also listed “left ankle pain” and “mild left ankle instability” as related Category II conditions (contributed to the primary unfitting condition but were not separately ratable). The impairment from these conditions was properly subsumed under the overall rating for the left ankle condition to avoid pyramiding (§4.14). The VA rated the left ankle condition 10%, analogously coded 5024 (tenosynovitis), based on the C&P examination, citing pain at the extremes of ROM, tenderness, inversion laxity and X-ray findings.

Panel members considered if the clinical evidence supported a 30% rating for a “severe” foot injury under code 5284 or a 30% rating for “marked” knee or ankle disability under code 5262, but agreed that a 30% rating under either code was not supported by the evidence. The panel also considered whether a higher rating was supported under other diagnostic code options, but since there was no ankylosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a rating higher than the 20% 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.

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 31 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 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.