RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03061
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090130

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Assaultman, medically separated for “loss of left subtalar motion both inversion and eversion” with a disability rating of 10%.

CI CONTENTION: The foot condition continues to worsen and negatively affects daily activities and employability. The CI also requested review of additional 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 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 – 20081113	VARD – 20091231	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Loss of Left Subtalar Motion	5299-5273	10%	S/P Left Ankle Surgery and Calcaneal Repair	5271	10%	20091030	
Mild Subtalar Post Traumatic Arthritis	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Loss of Left Subtalar Motion. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent surgical repair of a left calcaneus (heel) fracture in March 2008. At the 10 September 2008 MEB NARSUM examination, 4 months prior to separation, the CI complained of intermittent left heel pain that limited running or carry a heavy pack. The physical examination revealed a limping gait. Left ankle range of motion (ROM) testing showed dorsiflexion of 15 degrees (normal 20), plantar flexion of 45 degrees (normal) and inversion and eversion of 5 degrees. X-rays noted evidence of restored architecture to the left heel with hardware in position and good maintenance of joint space.

At the 30 October 2009 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported difficulty with standing and walking for long periods of time. He could not run or bend his left ankle normally. Physical examination revealed an antalgic gait with edema, effusion, weakness, tenderness and guarding of left foot movement.      Left ankle ROM

testing revealed dorsiflexion of 15 degrees and plantar flexion of 35 degrees with pain after repetition.  X-rays showed no indication of a malunion to the os calcis or astralgus.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left foot condition 10%, analogously coded 5299-5273 (os calcis or astragalus, malunion). The PEB also listed mild subtalar post-traumatic arthritis as a related diagnosis (Category II) contributing to the disability in this case. The panel concluded the Category II diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would a separate rating be achievable without pyramiding (§4.14). The VA rated the left foot condition 10%, coded 5271 (ankle, limited motion of), based on the C&P examination, citing moderate limited motion of the ankle with pain.

Panel members first agreed that the specific heel condition was associated with alterations within the adjacent ankle joint. Considerations for rating this impairment included VASRD codes of 5271 (limited ankle motion) or 5284 (foot injuries). In regards to ROM of the left foot, the usual parameters considered for impairment are the directional motions of dorsiflexion and plantar flexion, which in this case were either normal to only minimally diminished. Given the traumatic event, code 5284 is the most appropriate code for rating the impairment. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded that the overall functional limitations would be above a moderate (10%) condition and below a severe (30%) condition. The panel majority concluded that the overall condition supported an impairment described as moderately severe at 20%.

BOARD FINDINGS: In the matter of the left foot condition, the panel majority recommends a disability rating of 20%, coded 5271 IAW VASRD §4.71a. The single voter for dissent recommended no change 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, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Loss of Left Subtalar Motion	5284	20%	

The following documentary evidence was considered:

2	PD-2017-03061

IN REPLY REFER TO

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD DC 20374-5023

									                             1850
									                             CORB:003
                                                                                                                                                                            9 Jun 20 

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 of 31 Oct 19

1.  Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.   

2.  On 4 June 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR.  Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 10% to 20% without re-characterization of your discharge. 

3.  For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation. 

4.  The Assistant Secretary’s determination, which represents final action in your case by the Department of the Navy, has been forwarded to the office of the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.