RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-02430
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20091120

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Engineman, medically separated for “fracture of ankle [left]” with a disability rating of 10%.

CI CONTENTION: “Was only rated 10% with no retirement – should have been rated higher or retired.”  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 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 - 20090825	VARD - 20100104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Fracture Of Ankle [Left]	5099-5003	10%	
Left Ankle, Distal Fibula Fracture	
5271-5262	
10%	
20091203	
Ankle Joint Pain, Posterior Tibial Tendinitis	Cat II					
Ankle Joint Stiffness	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Left Ankle Fracture. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent left ankle surgery during March 2008 for a fibula fracture below the level of the syndesmosis (fibrous connection between the tibia and fibula above the ankle) and a proximal non-displaced fibula fracture. Ankle MRI on 7 October 2008 showed distal tibial edema, degenerative changes, healed fibular fracture, prior ligament damage, and diffuse synovitis. After surgery, nearly all (7/9) physical therapy and orthopedic examinations in record documented left ankle range of motion (ROM) of dorsiflexion (DF) to approximately neutral (0 degrees) with normal plantar flexion (PF) (normal 45 degrees), with painful motion. An orthopedic examination on 17 October 2008 noted dorsiflexion was limited by pain. Further surgery was discussed but not recommended. The CI was advised some of his injuries related to medial ankle pain may take up to 12 to 16 months to heal.

At a 17 April 2009 orthopedic examination, 7 months before separation, physical examination showed a normal appearing arch with limited ankle motion from neutral DF to PF of 50 degrees. There was tenderness along the medial malleolus and the posterior tibialis tendon. Hind foot and midfoot motion were normal and non-tender. The examiner’s assessment was persistent medial-sided joint pain due to deltoid ligament injury and medial osteochondral damage. He did not see any good surgical options. He noted the CI had a lace-up ankle brace, which he thought was a good treatment for the ankle. The 29 June 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant ankle pain. The CI reported he could not do any strenuous activity on the left ankle at all and had difficulty with stability and balance requiring the use of a CAM (controlled ankle motion) walker or an ankle brace all the time. No physical examination was performed. The 1 July 2009 physical therapy (PT) MEB addendum, 5 months prior to separation, noted the CI had plateaued in PT and was unable to progress on weight bearing and he was discharged. On examination there was tenderness and ankle ROM showed decreased DF, minus [lacking] 30 degrees and normal PF, with painful motion.

At the 3 December 2009 VA Compensation and Pension (C&P) examination, 2 weeks after separation, the CI reported ankle pain that interfered with daily activities, with walking longer than 45 minutes or standing more than 30 minutes, and occasional swelling. Physical examination showed a normal gait. There was tenderness of the ankle, without deformity or swelling. Ankle ROM measurements showed DF of 10 degrees and PF of 35 degrees, with pain. Active ROM did not produce any weakness, fatigue or incoordination and there was no additional loss of ROM after repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 10%, analogously coded as 5003 (degenerative arthritis). The PEB also listed ankle joint pain, posterior tibial tendinitis, and ankle joint stiffness as related Category II conditions that contributed to the primary unfitting condition but were not separately ratable. The panel agreed that impairment from the ankle joint pain, posterior tibial tendinitis and ankle joint stiffness were properly subsumed under the overall rating for the fracture of left ankle IAW §4.14 (avoidance of pyramiding). The VA also rated the left ankle condition 10%, analogously coded 5271-5262 (limited motion of the ankle - impairment of tibia and fibula), based on the C&P examination, citing malunion of the tibia and fibula with slight ankle disability.

In the STR, the CI’s limited DF was noted to be related to pain and the prognosis for the ligament and tendon injuries to heal was 12 to 16 months. At the VA examination, the most proximate examination to separation and most remote from surgery, a 10% rating was supported for moderately limited ankle ROM with painful motion and a normal gait. The panel considered other VASRD ankle and analogous codes and all were less applicable and/or not advantageous for rating. Although the panel’s recommendation is based on a different code than that of the PEB, there is no ratings benefit to the CI and no change to the PEB’s coding choice is recommended. 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 ankle joint pain, posterior tibial tendinitis 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 20170302, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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 28 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.

Copy to: PDBR