RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01950
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Trainee, medically separated for “left tibiofibular fracture, status post operative fixation and subsequent infection” 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 - 20060808	VARD - 20061116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Tibiofibular Fracture…	5271	20%	Status Post Open Reduction Internal Fixation of a Distal Tibiofibular Fracture …	5271	20%	20060711	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Tibiofibular Fracture.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI underwent a left ankle open reduction internal fixation (ORIF) on 10 October 2005 for a distal tibiofibular fracture.  Three days later he underwent a revision ORIF for mal-rotation of the previous surgery.  He did well until November 2005, when he experienced draining pus from the wound and was diagnosed with an infected tibia.  He then underwent four irrigation and debridement procedures over the next several months, and was placed on antibiotics for 6 weeks to treat presumed osteomyelitis.  After treatment was completed and X-rays demonstrated a union of his bone, he had a final operation in January 2006 for hardware removal.  During the procedure, the surgeon noted that the bone moved as a unit, was stable, and he had abundant bridging callus.  The CI was placed into a patellar tendon bearing cast, then a walking cast, and finally a controlled ankle motion walker. 

During the 25 May 2006 MEB NARSUM examination, 3 months prior to separation, the CI stated that he could not walk or run without pain, but ambulated without any casting or bracing.  On examination, there was no tenderness, and left ankle range of motion (ROM) showed dorsiflexion of 10 degrees (normal 20) and plantar flexion of 5 degrees (normal 45), with painful motion; knee ROM was full.  The incision scar was 20cm and well-healed with hypertrophic changes and the skin adhered to the bone.  There was intermittent paresthesia along the distal leg and foot, but sensation was intact and posterior tibial and dorsalis pedis pulses were excellent with 2+ capillary refill.  On standing, the CI’s foot pointed forward at approximately 0 degrees of external rotation, 18 degrees of inversion, and 9 degrees of eversion.  The provider opined that he was unlikely to complete the requirements of basic training.

At the 11 July 2006 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported constant, squeezing tibial pain, that was sharp and aching in nature.    On examination, left ankle ROM showed dorsiflexion of 15 degrees and plantar flexion of 40 degrees, with painful motion.  The examiner noted joint function was additionally limited by pain, which had the major impact, as well as fatigue and lack of endurance after repetitive use. Those factors (but not weakness or incoordination) additionally limited joint motion by 5 degrees.  The ankle had signs of edema and tenderness, but no deformity.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left tibiofibular fracture condition 20%, coded 5271 (limited motion of the ankle), citing marked limitation of motion with dorsiflexion of 10 degrees and plantar flexion of 5 degrees.  The VA also rated the left tibiofibular fracture condition 20%, coded 5271, based on the C&P examination, citing marked, limited motion of the ankle.  Members noted that the PEB assigned the maximum rating (20%) available under the diagnostic code 5271.  Because there was no anklyosis, nonunion or malunion, VASRD §4.71a offers no applicable joint code which would yield a higher rating.  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 tibiofibular fracture condition.  

BOARD FINDINGS:  In the matter of the left tibiofibular fracture 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 20170329, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010721, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure