RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04549
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060115

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Rifleman, medically separated for “os trigonum syndrome” 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 - 20051021	VARD - 20060203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Os Trigonum Syndrome	5299-5003	10%	Residuals, Status Post Right Ankle Fracture with Os Trigonum Syndrome	5271	10%	20051103	
Status Post Syndesmotic
Disruption	Cat III	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Os Trigonum Syndrome. According to the service treatment record and MEB narrative summary (NARSUM), the CI suffered a right ankle inversion injury in February 2004 while running and an X-ray revealed a spiral fracture (Maisonneuve) of the right fibula proximal to the ankle syndesmosis (a fibrous joint between two bones and linked by ligaments and a strong membrane), with gross disruption of the syndesmotic ligaments. He underwent an open reduction internal fixation of the fracture with stabilization of the ankle syndesmosis in March 2004.

The 6 September 2005 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of continued pain, stiffness, and an inability to run. Physical examination showed tenderness along the posterolateral aspect of the ankle, but no effusion or swelling. Testing for ankle instability (anterior drawer sign and a talar tilt test) was negative, and motor and sensory functions were intact. Ankle range of motion (ROM) measurements showed dorsiflexion to 12 degrees (normal 20) and plantar flexion to 40 degrees (normal 45), without painful motion. An orthopedic clinic note on 13 September 2005 indicated a bone scan showed diffuse uptake on both the distal tibia and talus, with non-specific findings. Given the diffuse nature of the uptake, the provider recommended an ankle MRI. At a follow-up visit on 6 October 2005, a ganglion cyst off the posterior subtalar joint was revealed from the MRI results. On examination, the CI had tenderness in the sinus tarsi for which he received an injection.

At the 3 November 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported throbbing right ankle pain with popping and grinding. Physical examination showed a normal gait and no assistive devices needed for ambulation. The examiner found there was an inversion and eversion deformity, and dorsiflexion was to 18 degrees and plantar flexion to 30 degrees, limited by pain. Right ankle X-rays were normal without any evidence of a fracture, dislocation, or destructive lesion. On 4 November 2005, the CI underwent a retrocalcaneal bursectomy (decompression of the ganglion cyst), and an X-ray on 28 December 2005, 1 month prior to separation, revealed no fracture or dislocation, with the ankle mortise intact and joint spaces preserved.

At the 18 April 2006 VA orthopedic consult, 3 months after separation, the CI reported pain on both the sides and back of the right ankle. Physical examination showed dorsiflexion to 10 degrees and plantar flexion to 45 degrees, with a positive posterior impingement sign and a trace positive drawer test. The Achilles tendon appeared intact, and the examiner documented “right ankle pain, etiology unclear.” Clinical findings were essentially unchanged at an orthopedic follow-up on 26 June 2006, and an MRI on 10 July 2006 showed an osteochondral injury with chronic changes at the posterior tibiotalar and at the subtalar articulation posteriorly, along with light fragmentation off the dorsum of the tibia. At an orthopedic appointment a month later, the provider assessed a possible persistent impingement and chondral injury to the superior talus.

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 (arthritis, degenerative). The VA also rated the right ankle condition 10%, but coded 5271 (ankle, limited motion of), based on the C&P examination, citing tenderness on palpation of both the front and back of the ankle. Panel members agreed that the ROM examinations proximate to separation were consistent with the “moderate” limitation of motion required for the 10% rating under code 5271, as adjudicated by the PEB. A higher 20% rating was not indicated in the absence of “marked” limited ankle ROM. The panel considered alternative VASRD ankle and analogous codes, but all were less applicable and/or not advantageous to 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 right os trigonum syndrome.

Contended PEB Condition: Status Post Syndesmotic Disruption. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The condition was listed on the 12 November 2004 limited duty form, 13 months prior separation and just after the first surgery. On the same day, the MEB recommended a second period of limited duty. The condition was not referred by the 6 September 2005 MEB to the PEB, and was not implicated in the commander’s non-medical assessment. There was no specific performance- based evidence from the record that the syndesmotic disruption 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 the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the right os trigonum syndrome and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended syndesmosis ligament condition, the panel recommends no change from the PEB determination 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.

The following documentary evidence was considered:

DEPARTMENT OF THE NAVY
SECRETARY OF TI-!E 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:

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.