RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02945 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20090202

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Aviation Electronic Technician, medically separated for “post-traumatic right ankle pain, after ankle fracture” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20081027	VARD - 20090626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Pain…	5099-5003	10%	Residuals, Fracture of the Right Tibia and Fibula (Also Claimed as Right Ankle Fracture)	
5262	
20%	
20090518	
Decreased Tolerance to High Impact Activities	Cat II					
Joint Pain, Localized in the Ankle	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	
	
ANALYSIS SUMMARY:

Right Ankle Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right ankle surgery in March 2007 for a distal fibular fracture, and a second surgery in April 2007 for a syndesmotic screw adjustment. He had a final surgery in August 2007 for a sydesmosis reduction revision to bolt the tibia and fibula together.

The 27 May 2008 MEB NARSUM examination, 8 months prior to separation, noted CI complaints of constant right ankle pain of varying intensity. Exacerbating factors included walking, running and standing for greater than 30 minutes. Physical examination showed a swollen right ankle with no effusion. The examiner noted right ankle range of motion (ROM) was “good” and neurovascularly intact with four surgical scars on the ankle. Strength was normal, deep tendon reflexes were present and equal bilaterally with no sensory deficits elicited, and muscle tone was normal. During the MEB examination (recorded on DD Forms 2807-1 and 2808), 2 days later, the examiner noted that the  CI  walked  with a limp and had painful toe  walking.   At the    physical

therapy (PT) appointment on 7 October 2008, 4 months before separation, the CI reported pain along the posterior tibia tendon when he walked. On examination, he was “strong and pain free” on the posterior tibia and cardinal planes of the right ankle. Right ankle ROM was within normal limits and there was tenderness over the posterior tibialis tendon.

At the 18 May 2009 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported right ankle pain most of the time, but also dependent on his activity. He had ankle swelling, numbness, tingling and burning up into his calf 1-2 times a day for 30 minutes. He used a brace or wore high boots to support his ankle and intermittently used a cane. Physical examination showed tenderness over the right ankle, lower leg, arch of the foot and lateral malleolus. Gait was normal and there was no loss of right lower extremity sensation. Right ankle dorsiflexion was to 5 degrees (normal 20) and plantar flexion to 6 degrees (normal 45), and repetitive motion caused increased pain. Ankle X-rays on 18 May 2009 revealed a plate and multiple screws, with the ankle mortise and the subtalar joints within normal limits.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition 10%, analogously coded 5003 (arthritis, degenerative), and also listed “decreased tolerance to high impact activities” and “localized ankle joint pain” as related Category II conditions (contribute to the primary unfitting condition but not separately ratable). Panel members agreed that the impairment from these conditions were properly subsumed under the overall rating for the right ankle pain condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated the residuals of right tibia/fibula condition 20%, coded 5262 (tibia and fibula, impairment of), based on the C&P examination, citing malunion of the tibia and fibula with moderate knee or ankle disability. The panel agreed that while there was no compensable limitation of ankle dorsiflexion or plantar flexion (5271) at the NARSUM and PT examinations prior to separation, there was pain with use and swelling supporting a 10% rating for functional loss (§4.40 and 4.59). The post-separation C&P examination showed findings of dorsiflexion and plantar flexion that were inconsistent with previous ROMs before separation with was no explanation for the decline in ROM. 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 right ankle condition.

BOARD FINDINGS: In the matter of the right ankle 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

2	PD-2017-02945

DEPARTMENT OF THE NAVY
SECRETARY OF TI-IE 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 <ltd 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.