RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-02818
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20070114

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Information Systems Technician, medically separated for “type 3A open distal tibia and fibula fracture right leg status post iliac crest bone graft and plating,” with a disability rating of 10%.

CI CONTENTION: “I had a torn meniscus that was not discovered until I had already separated. I’ve also been told that my knee has begun to show signs of arthritis and that I may need a knee replacement in the future.” 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 - 20061207	VARD - 20070730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type 3A Open Distal Tibia and Fibula Fracture Right Leg	5299-
5003	10%	Status Post Compound Fracture of the Right Ankle	5271-5262	30%	20061204	
Chronic Right Knee Pain	Cat II	Right Knee Patellofemoral
Syndrome	5299-5261	10%	20061204	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Open Distal Tibia and Fibula Fractures, Right Leg. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgery in August 2005 after a motorcycle accident with placement of an intramedullary nail to the right tibia and an open reduction internal fixation of the right distal fibula. In November 2005, because of no evidence of union, the CI underwent an iliac crest graft; however, the fracture didn’t heal so he underwent removal of the intramedullary nail and medial plating of his tibia and another bone graft in March 2006. In August 2006, orthopedics noted radiographic evidence of healing/callus formation.

The 28 September 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent pain in the right distal tibia, ankle and knee. Physical examination

showed no tenderness over the fracture site, but the CI had tenderness about the medial and lateral plates. He could bear full weight in a CAM walker. There was mild medial joint line tenderness of the right knee with positive patellar compression and apprehension tests, and crepitance (grinding sensation) of the patellofemoral joint. He had a stable endpoint with Lachman’s test and no instability with varus or valgus stress. Muscle strength of the right lower extremity (RLE) was normal, but he had significant quadriceps atrophy. X-rays of the right knee demonstrated some mild calcification along the medial joint line, but was otherwise unremarkable. X-rays of the tibia demonstrated what appeared to be a solid union of both the tibia and fibula.

At the 4 December 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported right ankle numbness, pain, sensitivity, limited range of motion (ROM), and regular use of an orthopedic boot. He also had right knee pain, give-way and increased heat when swollen. Physical examination showed a limp on the right, but the CI was wearing a large orthopedic boot. There was mild edema of the right ankle, but no increased heat or redness. Right ankle dorsiflexion was 9 degrees (normal 20) and plantar flexion was 35 degrees (normal 45) without pain. There was no loss of function with repetition. Right ankle X-rays showed surgical changes present with plate and screw fixation of the distal tibia and fibula fractures with mature callus and osteopenia (decreased mineralization of the bones) of the foot likely due to disuse. The right knee had no deformity, edema, effusion, increased heat or redness and there was no tenderness over the medial joint line, lateral joint line, quadriceps tendon, patellar tendon or popliteal area tendons. Anterior drawer and Lachman tests (to determine instability) were negative and there was no varus/valgus laxity. McMurray’s test (to determine a meniscal tear) was negative. The patella was very lax with crepitation. Right knee flexion was 112 degrees (normal 140) and extension was -7 degrees (normal 0), both without pain, and there was no loss of joint function on repetition. X-rays of the right knee demonstrated evidence of prior intramedullary nail removal from the tibia with no acute abnormality identified.

The right ankle hardware was removed on 2 July 2007, 6 months after separation. At an internal medicine clinic visit on 27 July 2007, 7 months after separation, the CI reported doing well since surgery, and walked around without any difficulty. Although he had no fever, chills or drainage, he noted the RLE was weak and there were popping sounds from the right knee as well as aching and pain while walking short distances.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the RLE condition 10%, analogously coded 5299-5003 (arthritis, degenerative). The PEB also listed chronic right knee pain as a related Category II condition (contributed to the primary unfitting condition but was not separately ratable). The impairment from the right knee pain was properly subsumed under the overall rating for the RLE condition to avoid pyramiding (§4.14). The VA rated the RLE condition 30%, dual coded 5271-5262 (limited motion of the ankle due to tibia and fibula impairment), based on the C&P examination, citing a compound fracture of the right distal tibia and fibula, surgery, and right ankle limited ROM. The VA also rated the right knee condition 10%, analogously coded, 5299-5261 (leg, limitation of extension), based on the C&P examination, citing 7 degrees of extension.

Panel members noted the CI sustained open distal tibial and fibula fractures and underwent several surgical procedures. Since the fractures healed proximate to separation, although there was retained hardware, use of code 5299-5262 with a 30% rating is reasonable and appropriate according to the panel majority since proximate to separation the CI had a limp and wore a large orthopedic boot on the right. Additionally dorsiflexion, plantar flexion, inversion and eversion of the right ankle and flexion and extension of the right knee were reduced, the patella was very lax and there was crepitation of the right knee. The panel considered separate and/or combined ratings using ankle, knee or leg codes, but this did not offer a rating higher than 30%. Although the minority panel member favored a 20% rating for moderate knee or ankle disability due to

impairment of the tibia and fibula, the panel majority noted that the 20% rating fails to take into account the combined disability of both the right ankle and right knee findings at the time of separation as a result of the fractures and multiple surgeries. Therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 30% for the RLE condition, coded 5299-5262.

BOARD FINDINGS: In the matter of the RLE condition, the panel majority recommends a disability rating of 30%, coded 5299-5262 IAW VASRD §4.71a. The single voter for dissent recommended modification to 20% but did not elect to submit a minority opinion. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Open Distal Tibia and Fibula Fractures, Right Leg	5299-5262	30%	

The following documentary evidence was considered:

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
6040
CORB:003 14 May 21

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXXXXXXXX

Subj:	Physical Disability Board of Review Determination Ref:	(a) 6040.44(Series)
1.	The Physical Disability Board of Review (PBDR) reviewed your case in accordance with reference
(a) and forwarded their recommendation for action.

2.	On 23 April 2021 the Assistant Secretary of the Navy (Manpower and Reserve Affairs) accepted the PDBR’s recommendation of an increase in disability rating to 30% and placement on the Permanent Disability Retired List effective the date of your discharge. This decision was then sent to Navy Personnel Command for appropriate action.
3.	The PDBR determination is final and not subject to appeal or review.