RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXX	CASE: PD-2017-03565
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080317

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Communication Security Maintenance Technician, medically separated for “chronic right ankle instability/pain” with a disability rating of 10%.

CI CONTENTION: Review requested of the right ankle as well as additional conditions identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) as Category III. 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 - 20071231	VARD - 20080711	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Ankle Instability Pain	5024	10%	Chronic Right Ankle Sprain	5271	10%	STR	
Chronic GERD	Cat III	Barrett’s Esophagitis, Gastritis	7399-7346	0%	STR	
Barrett’s Esophagus	Cat III					
Asthma, Stable	Cat III	Asthma	6602	0%	STR	
Sensorineural Hearing Loss, Stable	Cat III	No VA Placement	
Allergic Rhinitis	Cat III	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Chronic Right Ankle Instability Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained a severe right ankle sprain and underwent a modified Brostrom lateral ligament reconstruction surgical procedure in November 2005, with physical  therapy  (PT)  thereafter.    An  MRI  in  July  2006  showed  significant  thickening   and

interstitial tearing of both the peroneus longus and peroneus brevis tendons with a longitudinal slit of the peroneus brevis tendon, which appeared grossly intact both proximally and distally. On 17 January 2007, the CI had a second Brostrom procedure along with a peroneal brevis tendon repair and calcaneal osteotomy for continued instability. At the 20 August 2007 PT examination, 6 months prior to separation, dorsiflexion was to 15 degrees (normal 20) and plantar flexion to 35 degrees (normal 45) with pain elicited by motion in the lateral aspect. Despite the surgeries, postoperative PT, and an ankle brace, pain and chronic instability persisted.

The 15 October 2007 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of right ankle pain, swelling, and instability. Physical examination showed right ankle stiffness and diffuse tenderness but no swelling. At the MEB orthopedic consult a week later, dorsiflexion was to approximately 30 degrees and plantar flexion to 60 degrees. Tenderness was present on the anterior joint line as well as on the peroneal tendons, and strength was 3/5 strength on inversion and eversion, and “good” with dorsiflexion and plantar flexion. The examiner’s diagnosis was right ankle pain with instability due to injury to the peroneal tendons and ankle weakness. During the 31 October 2007 MEB examination (recorded on DD Forms 2807- 1 and 2808), 4 months before separation, physical examination revealed range of motion loss with crepitus, pain and stiffness.

At the 22 May 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported localized right ankle pain rated at 6/10, which increased with activity and caused functional impairment. Physical examination showed tenderness with slight subluxation, but no edema, effusion, weakness, redness, heat or guarding of movement. Dorsiflexion was to 20 degrees and plantar flexion to 40 degrees, with pain at the end of the motion.  Additional function was limited after repetition with pain being the major factor.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition 10%, coded 5024 (tenosynovitis). The VA also rated the right ankle condition 10%, but coded 5271 (ankle, limited motion), based on the C&P examination, citing moderate limited motion of the ankle. Panel members agreed that a 10% rating for functional loss (§4.40, §4.45, §4.59) due to instability and pain was appropriate and in concert with the adjudication by the PEB. The panel further noted that while the CI had right ankle dorsiflexion of 15 degrees at the PT examination, 6 months prior to separation, dorsiflexion and plantar flexion were normal at both the orthopedic and VA C&P examinations most proximate to separation. Therefore, use of code 5271 was not applicable. The panel then considered alternative VASRD ankle and analogous codes as well as moderately severe disabilities using code 5311 (Group XI (peroneus longus and peroneus brevis) or code 5284 (foot injuries), but both were less applicable and/or not advantageous to achieve a higher 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 right ankle pain condition.

Contended PEB Conditions: Chronic GERD, Asthma, Sensorineural Hearing Loss, Barrett’s Esophagus, and Allergic Rhinitis. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Both the GERD and asthma conditions were noted on limited duty forms and implicated in the non-medical assessment. The CI was followed by gastroenterology for esophageal reflux for years, and an endoscopy showed a small hiatal hernia as well as Barrett’s esophagus (irritation of the esophagus due to reflux where tissue lining the esophagus becomes similar to lining of the intestine) was found in 2000. A repeat examination in 2004 showed some more inflammation, and he was treated with rabeprazole (a protein pump inhibitor), which was changed to omeprazole in August 2006. On 21 September 2007, he reported he was doing well and denied any dysphagia (difficulty swallowing) or odynophagia (painful swallowing or feeling a lump in the throat). Esophageal biopsies taken on 20 September 2007 revealed mild chronic inflammation of the distal esophagus

and no metaplasia (change in form of the tissue). His symptoms were noted to be well-controlled with proton pump inhibitor medication. The CI had mild asthma as a child and symptoms recurred on active duty around 2000-2001, with evaluation in January 2002 confirming the diagnosis. His symptoms remained stable with treatment consisting of Advair (inhalational steroid/bronchodilator combination) and albuterol (inhalational bronchodilator) 2-3 times a month as needed. Neither of the sensorineural hearing loss or allergic rhinitis was noted on limited duty forms or implicated in the non-medical assessment. There was no performance- based evidence from the record that any of the contended conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the right ankle condition and IAW VASRD §4.71 the panel recommends no change in the PEB adjudication. In the matter of the contended chronic GERD, asthma, sensorineural hearing loss, Barrett’s esophagus, and allergic rhinitis, the panel recommends no change from the PEB determinations as not unfitting. 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

DEPARrnENT 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) PDBRltr

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.