RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-02868
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050515

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Combat Engineer, medically separated for “left distal fibula fracture” with a disability rating of 20%.

CI CONTENTION: In addition to the left fibula fracture, the CI 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’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 - 20050311	VARD - 20050928	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Open Reduction Internal Fixation of His Open Left Distal Fibula Fracture	5099-5003	20%	Status Post ORIF of Left Distal Fibula Fracture Secondary to Blast Injury	
5312	
10%	
20050809	
Open Left Distal Fibula Fracture, Status Post
Blast Injury	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Status Post Open Reduction Internal Fixation of His Open Left Distal Fibula Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI sustained a left distal fibula fracture on 1 May 2004 after a combat related blast injury. He was treated initially in the field with debridement and irrigation and was then medically evacuated for treatment of the fracture. On 7 May 2004, he underwent another debridement and irrigation of his left lateral ankle injury and a wound VAC (vacuum-assisted closure) was applied. On 11 May 2004, he

underwent ORIF (open reduction internal fixation) with split thickness graft and placement of a VAC dressing.

On 4 August 2004 the CI was non-weight bearing in a CAM walker with crutches. Left ankle plantar flexion was 10 degrees (normal 45) and dorsiflexion was to neutral (normal 20 degrees). The incision was healed and the graft took well, but sensation was decreased. On 9 August 2004 the CI had 40 degrees of plantar flexion but lacked 5 degrees dorsiflexion. On 15 September 2004 plantar flexion was 30 degrees and dorsiflexion was 20 degrees, both with normal strength. At an orthopedic clinic dated 20 October 2004, the CI was weight bearing as tolerated. Dorsiflexion was 10 degrees and plantar flexion was 20 degrees. At an orthopedic clinic visit on 4 February 2005, dorsiflexion was 10 degrees and plantar flexion was 15 degrees, and there was lateral tenderness.

During the 24 February 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported reoccurring left foot and lower extremity pain. Physical examination revealed decreased range of motion (ROM) for flexion and extension of the foot and decreased muscle strength. The 24 February 2005 MEB NARSUM examination, 3 months prior to separation, noted the complaint of left ankle pain. Physical examination showed full active ROM of the left knee without any evidence of open wounds or soft tissue trauma. The ROM evaluation of the left ankle demonstrated 10 degrees of dorsiflexion and 15 degrees of plantar flexion. The left ankle was painful both in extreme plantar flexion as well as dorsiflexion, and was tender over the lateral plate. He had a well-healed surgical and traumatic wound about his left ankle with some scarring of his underlying peroneal muscles to his superficial fascia along with dimpling of the skin with eversion of his ankle. The deltoid and calcaneofibular ligaments were nontender. Neurovascular examination was intact to light touch except for some mild diminished sensation along the superficial peroneal nerve distally.

At the 9 August 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported walking with a limp and had no pain in the left ankle except on cold days when the fibular plate felt like an “ice cube.” Physical examination showed a 12 cm well- healed, non-keloid trauma-incisional scar on the distal aspect of the left fibula. There was mild tenderness over the screws just under the skin of the left distal fibula. ROM measurements of the left foot without pain were plantar flexion of 40 degrees and dorsiflexion of 20 degrees. There was a mild pain and pulling sensation of the fibula on extreme inversion of the left foot.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left distal fibula fracture 20%, analogously coded 5099-5003 (arthritis, degenerative), although there was no documentation of “X-ray evidence of involvement of two or more major joints or two or more minor joints, with occasional incapacitating exacerbations.” The Navy PEB also listed “open left distal fibula fracture, status post blast injury” as a related Category II condition (contributed to the primary unfitting condition but was not separately ratable). The impairment from the “open left distal fibula fracture” was properly subsumed under the overall rating for the left distal fibula fracture IAW §4.14 (avoidance of pyramiding). The VA rated the left distal fibula fracture 10%, coded 5312 (muscle group XII function), based on the C&P examination, citing moderate muscle disability.

There was no limitation of dorsiflexion or plantar flexion that supported a rating under the VASRD code for limitation of motion (5271) higher than 10% since there was no evidence of marked limitation of ankle motion proximate to separation. The panel noted the underlying cause for the ankle impairment was the residual of a fracture of the fibula and considered a rating using the VASRD diagnostic code 5262 (impairment of the tibia, fibula and ankle). However, there was no nonunion or malunion present to support that approach at the time of separation. There was no ankylosis of the ankle or subastragalar (sub-tarsal) joints, no malunion of the os calcis (calcaneus) or astragalus (talus), and no astragalectomy for consideration under the respective

diagnostic codes (5270, 5272, 5273 or 5274). The panel noted the VA used code 5312; however, there was no evidence of either a moderately severe or severe muscle injury at the time of separation. 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 distal fibula fracture.

BOARD FINDINGS: In the matter of the left distal fibula fracture 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:

DEPARTMENT OF THE NAVY
SECRETARY OF TI!E NAVY COUNCIL OF REVIEW BOARDS
72 0 KENNON STREET SE STE 309 WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB: 003
10 Sep 20

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

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 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.