RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-03569 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Logistics Vehicle Systems Operator, medically separated for “status post (S/P) left lateral ankle stabilization for rupture of his anterior talofibular ligaments and calcaneofibular ligament times 3” with a disability rating of 20%.

CI CONTENTION: “… I should be compensated for all service connected problems.” He 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’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 - 20050128	VARD - 20050706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Ankle [Surgical Residuals as Above]	5099-5003	20%	Residuals, Post- Operative Left Ankle	5299-5271	10%	
20050402	
Status Post Excision of Fourth
Interspace Neuroma x 2	Cat II	Numbness Left Fourth and Fifth Toes	8599-8523	0%		
Left Foot Ganglion Cyst Removal ...						
Sinus Tarsi Syndrome Bilaterally	
Cat III	No VA Placement	
Gastroc Soleus Equinus Bilaterally			
Low Back Pain		Thoracolumbar Strain	5237	10%	20050402	
Pes Planovalgus Bilaterally		Bilateral Pes Planus	5276	NSC		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Left Ankle and Surgical Residuals (Subsuming Category II Conditions [Charted Above]). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered a severe left ankle strain in January 2003 and was subsequently diagnosed with anterior talofibular and calcaneofibular ligament tears confirmed by arthroscopy. This resulted in a series of three surgical interventions. An initial Brostrom repair failed, requiring repeat surgery (modified Brostrom) in April 2004. The pain persisted and a final surgical revision, with release of entrapped anomalous muscles, was performed in October 2004 (6 months before separation).

There were no clinical STR provider entries in evidence for the period between the final surgery and separation. Entries leading up to the final surgery documented mild instability (anterior drawer), mild reduction in joint strength (4/5) and restoration of a normal gait. Measured range of motion (ROM) just before the final surgery was dorsiflexion to 5 degrees (normal 20) and plantar flexion to 45 degrees (normal). In addition to the above, the CI was diagnosed with a ganglion cyst and neuroma (fourth interspace) of his left foot. These were excised concurrently with the second ankle surgery. The NARSUM noted an additional procedure for release of the neuroma that was not identified elsewhere in the STR. Post-operative podiatry notes indicated improvement, but residual pain at the incision sites (possibly neuritis with a positive Tinel’s) that was rated 2-3/5 in an entry after the final surgery. At the 6 December 2004 MEB NARSUM examination, 5 weeks post-surgery and 5 months prior to separation, the CI was still in a controlled ankle motion (CAM) walker and reported continued pain. The physical examination recorded tenderness confined to the neuroma site, resolution of the instability (negative drawer) and pain with dorsiflexion (ROM measurements deferred).

At the 2 April 2005 VA Compensation and Pension (C&P) examination, the month of separation, the CI reported, “sharp and tingling pain” of the lateral ankle “everyday ... about two hours.” There was a complaint of numbness confined to the lateral toes, but no note of pain with regard to the ganglion cyst/neuroma condition. The examiner specified no incapacitation and no pain with standing or walking, and opined that there was no functional impairment. The physical examination recorded a normal gait (no brace or assistive device), tenderness over the ankle and foot surgical scars, no objective sensory deficit and normal joint strength. The examiner noted a “mild inversion deformity” of the left ankle consistent with the NARSUM diagnosis of pes planovalgus (see below). Measured ROM was normal in both planes, specifying the absence of painful motion and no pain or ROM degradation with repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left ankle condition 20%, coded 5099-5003 (analogous to degenerative arthritis). Although no criteria or rationale was cited by the PEB, the maximum 20% rating of code 5003 specifies “occasional incapacitating exacerbations.” The VA rated the condition 10%, coded 5299-5271 (analogous to limitation of ankle motion), based on the C&P examination and citing only the inversion deformity (not a VASRD-specified criterion for ankle rating). The highest rating offered by code 5271 is 20% for “marked” limitation of motion. The VA conferred an additional 0% rating for subjective left foot numbness under code 8599-8523 (analogous to anterior tibial nerve paralysis), citing failure to satisfy the 10% criterion of “moderate” nerve impairment.

The panel first addressed the PEB’s Category II conditions (contributing to the unfitting condition but not separately ratable) of ganglion cyst and neuroma. They were interrelated with the pain and disability from the ankle condition, although they were possibly distinct enough to consider a separate rating for foot pain (subsuming both the ganglion cyst and neuroma) without violating VASRD §4.14 (avoidance of pyramiding). That notwithstanding, the only residuals of the Category II diagnoses in evidence at separation were subjective numbness and scar tenderness. Members agreed that these imposed no significant limitations on fitness, thus could not be

justified for separate service rating, and were appropriately subsumed with the unfitting condition.

The panel then deliberated the appropriate rating for the ankle condition. It was noted that the NARSUM was in fairly close proximity to surgery, prior to satisfactory recovery. Therefore, the evidence from the C&P examination shortly before separation was most probative to the panel’s recommendation. There was no ankylosis, nonunion, malunion, or other ratable criterion in evidence that would support a rating higher than 20% under any applicable joint code available in VASRD §4.71a. The panel considered a 30% rating for functional impairment under analogous code 5299-5284 (foot injuries, other) for “severe” disability, or under analogous code 5299-5262 (tibia and fibula, impairment of) for “marked” contiguous ankle disability. Panel members agreed, however, that neither was supported by the functional impairment in evidence at separation, i.e., normal gait and mobility with no specified occupational limitations. 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 ankle condition and associated Category II diagnoses.

Contended PEB Conditions: Sinus Tarsi Syndrome Bilaterally, Gastroc-Soleus Equinus Bilaterally, Low Back Pain, Pes Planovalgus Bilaterally. Sinus tarsi syndrome refers to nerve or other tissue entrapment in the tarsal tunnel between the ankle and hindfoot. Gastroc-soleus equinus refers to a shortened Achilles tendon at the attachment of calf muscles which may affect ankle motion. These diagnoses were listed in the NARSUM without note of associated symptoms or examination findings. The only STR evidence for sinus tarsi syndrome was a single reference to tenderness over the sinus tarsi on the left side only. An entry for transient left calf pain with early use of a CAM walker was the only evidence possibly linked to gastroc-soleus equinus. Thus, any impairment attributable to either of these conditions would have been subsumed with the left ankle rating.

The STR documented an atraumatic onset of low back pain about 9 months before separation. There were scant STR entries related to the complaint, the last of which stated that the CI “reports doing much better.” The NARSUM listed a diagnosis of mechanical low back pain without further elaboration. The C&P examiner opined that there was no functional impairment from back pain. Bilateral pes planus (elaborated as planovalgus in the NARSUM) was present on service entry and treated by orthotics with no noted subsequent complaints. None of these conditions were noted on limited duty forms, implicated in the in the commander’s non-medical assessment, or incompatible with retention standards.

The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting (Category III). There was no performance-based evidence from the record that any of them 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 Category III adjudication for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the left ankle condition (subsuming the above Category II conditions) and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended bilateral sinus tarsi syndrome, bilateral gastroc-soleus equinus, low back pain and bilateral pes planovalgus, the panel recommends no change from the PEB determinations as Category III. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends that there be no modification or re- characterization of the CI’s disability and separation determination.

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
10 Sep 20

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

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.