RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX		CASE: PD-2017-03245 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20051216

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Airman, medically separated for “status post open reduction, internal fixation [ORIF], right ankle fracture (maisonneuve fracture with distal one- third fibula fracture and syndesmosis disruption)” with a disability rating of 10%.

CI CONTENTION:  Review all conditions.  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’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 - 20050925	VARD - 20060627	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post ORIF, Right Ankle Fracture...	5299-5003	10%	Residuals, Status Post Fracture Right Ankle	5010-5271	10%	20060515	
Continued Chronic Right Ankle Pain	Cat II					
Late Effect of Fracture of Lower Extremities	Not Addressed	Residuals, Status Post Fracture Right Fibula	5010-5262	0%	20060515	
COMBINED RATING: 10%	COMBINED RATING: 10%	

ANALYSIS SUMMARY:

Status Post Open Reduction, Internal Fixation, Right Ankle Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured his right ankle while playing football and underwent an ORIF on 15 March 2004. Although the fracture healed, he continued to have significant right ankle pain. In March 2005, he had a second surgical procedure

to remove the previously placed orthopedic hardware. Despite aggressive physical therapy (PT), the pain persisted. The 10 August 2005 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of daily, intermittent to moderate right ankle pain that was activity-related. Prolonged standing, walking on uneven terrain, or forceful pushing and pulling of any heavy objects reproduced the ankle pain. The physical examination (PE) revealed decreased right ankle range of motion (ROM) noting 10 degrees of dorsiflexion (normal 20) and 35 degrees of plantar flexion (normal 45). There was tenderness over the surgical incisions and light touch sensation was intact throughout all nerve distributions in the feet.

At the 15 May 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported continued right ankle pain as well as decreased sensation (numbness) over the bottom aspect of the right foot. The PE revealed full right ankle ROM and “slight” decreased sensation as subjectively described.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition 10%, analogously coded 5299-5003 (degenerative arthritis), and also listed “right ankle pain” as a related Category II condition (contributes to the primary unfitting condition but not separately ratable). Panel members agreed that the impairment from the right ankle pain was properly subsumed under the overall rating for the right ankle fracture IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated the right ankle condition 10%, dual coded 5010-5271 (arthritis, due to trauma ankle, limited motion), based on the C&P examination, citing painful motion and weakness. The VA also rated residuals of the right leg condition 0%, dual coded 5010-5262 (arthritis, due to trauma-tibia and fibula, impairment), based on the C&P examination, citing absence of bony malunion with slight ankle disability. The panel agreed that the greatest probative value be apportioned to the MEB NARSUM, which was prior to and more proximate to separation. When considering rating options under codes 5271 and 5284 (foot injuries; other), panel members agreed that both the limited ankle motion and disability from the foot injury were no greater than “moderate” under both codes, and warranted a 10% rating in either case. 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.

Contended Condition: Late Effect of Fracture of Lower Extremity. The PEB did not address the condition in its adjudication, and thus the panel considered whether or not it was unfitting. There were no limited duty forms in evidence for the condition forwarded by the MEB, and the commander’s non-medical assessment did not implicate any specific condition. Additionally, the PEB did not comment on whether the condition failed or did not fail retention standards. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend the contended condition as separately unfit, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the right ankle condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended late effect of fracture of lower extremity the panel agrees it cannot recommend it for additional disability rating. 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 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 16 May 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.

Copy to: PDBR