RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02828 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090227

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Electronic Countermeasures Systems Technician, Fixed Wing, medically separated for “chronic ankle instability” with a disability rating of 10%.

CI CONTENTION:  Review of all conditions requested. 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 - 20081119	VARD - 20090901	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Ankle Instability	5099-5003	10%	
Chronic Recurrent Ankle Pain	
5271	
20%	
2009	
S/P Post Anterior Stabilization of Ankle and
Excision of Os Trigonum	Cat II					
Ankle Pain	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	
	
ANALYSIS SUMMARY:

Chronic [Left] Ankle Instability. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left ankle surgery in February of 2007 for a Brostrom procedure to correct an unstable ankle and an excision of a fractured os trigonum. Because of left ankle pain and recurrent instability, she again underwent left ankle surgery consisting of left ankle arthroscopy and a revision of the Brostrom procedure in February 2008. Despite physical therapy and a lace-up brace, she continued to have pain, although the ankle felt more stable.

The 9 September 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of not being able to walk for more than 400 yards continuously and not being able to stand for longer than 15 minutes without debilitating pain. Physical examination showed the CI walked normally with a lace-up ankle brace. There was swelling at the lateral aspect of the ankle, but no effusion.  Palpation of an incisional scar over the distal fibula revealed tenderness   from

the Brostrom procedure. Range of motion (ROM) of the left ankle was 15 degrees of dorsiflexion (normal 20) and 40 degrees of plantar flexion (normal 45), which was roughly equal to motion on the right ankle. Painful motion was present with anterior drawer testing, but there was no crepitus (grinding sensation) with motion of the ankle. X-rays of the ankle showed no tarsal coalition and normal changes after the Brostrom procedure. There was no evidence of talus subluxation in the mortise.

During the 24 September 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported stability had improved, but she was still wearing a support brace and still had persistent pain. Physical examination showed the ankle was tender. There was full ROM with painful motion, but there was no swelling, erythema, or warmth. X-rays of the left foot dated 27 May 2009 demonstrated no fractures, dislocation, bony erosions, or periosteal reactions. The soft tissues were unremarkable and there were no calcaneal bone spurs, but there was tendon fixation at the tip of the lateral malleolus.

There was no VA examination proximate to separation in evidence. However, there was a VA Rating Decision (VARD) from 1 September 2009, which provided a rationale for the decision pertaining to the CI’s ankle condition, based on an either May or July 2009 post separation VA Compensation and Pension (C&P) examination, where the CI reported being unable to exercise due to the left ankle pain. Physical examination (not in evidence) was reported to show she had a normal heel-to-toe reciprocal gait bilaterally while wearing a lace-up ankle brace. ROM measurements were dorsiflexion to 15 degrees and plantar flexion to 40 degrees. There was evidence of painful motion. There was no gross instability, edema, callus ulceration, or tenderness about the ankle noted.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 10%, analogously coded as 5099-5003 (degenerative arthritis). The PEB also listed status post (s/p) anterior stabilization of ankle and excision of os trigonum and ankle pain as related Category II conditions that contributed to the primary unfitting condition but were not separately ratable. The impairment from this condition was properly subsumed under the overall rating for the chronic ankle instability IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated the left ankle condition 20%, coded 5271 (limited motion of ankle), based on the C&P examination, citing marked limitation of motion of the ankle.

The panel considered if the limitation of motion was “moderate” or “marked” when considered under 5271, limitation of ankle motion. All panel members agreed the limitation of motion was no more than “moderate,” as noted during the NARSUM examination, therefore supporting the 10% rating adjudicated by the PEB. A higher rating of 20% was not indicated in the absence of “marked” limited ROM of the ankle. The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and not advantageous to 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 chronic ankle instability condition.

BOARD FINDINGS: In the matter of the chronic ankle instability 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 20170220, 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 29 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.