RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05999
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20040622

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Machinist Mate, medically separated for “failed Brostrom repair (right ankle)” with a disability rating of 20% with a 10% reduction for existing prior to service (EPTS).

CI CONTENTION: “Damage to left hand. Never accounted.” The CI 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 - 20040319	VARD - 20041209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Ankle Failed
Brostrom Repair	5099-5003-
8724	20% (with EPTS 10%
deduction) = 10%	Right Ankle
Condition	5271	10%	20041101	
Peroneal Tendinitis	
Cat II	
No VA Placement	
Sural Nerve Neuroma			
Suture Granuloma			
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Right Ankle. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a right ankle arthroscopy with a Brostrom repair (ligament stabilization surgery) in May 2003 for a torn anterior talo-fibular ligament and associated peroneal tenosynovitis. The 9 February 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of right ankle pain upon weight bearing. The physical examination (PE) revealed right ankle dorsiflexion of ‘neutral,’ equivalent to 0 degrees (normal 20). Plantar flexion was 45 degrees (normal). Tenderness was globally present about the right ankle. An anterior drawer test on the right ankle was positive, but no grade or amount of joint movement was documented.

At the 1 November 2004 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported right ankle pain, but not on a daily basis. The CI endorsed pain aggravation with prolonged driving and walking. Her PE revealed a limped gait favoring her right side. The right ankle ROM noted normal dorsiflexion and plantar flexion of 40 degrees. Painful motion was present.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right ankle condition initially at 20% and then applied a 10% deduction for an EPTS historical condition; thus their final adjudication was 10%, analogously coded 5099-5003-8724 (neuralgia internal popliteal nerve). The PEB also listed peroneal tendinitis, sural nerve neuroma and suture granuloma conditions as related Category II diagnoses contributing to the primary disability in this case. Panel members deliberated and thus concluded that the Category II diagnoses were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA rated the right ankle condition 10%, coded 5271 (ankle; limited motion), based on the C&P examination, citing moderate limited motion of the ankle.

Panel members first noted the vast clinical improvement of right ankle ROM from a significant loss 4 months prior to separation to near normal parameters 6 months after separation which indicated appropriate post-operative healing. Members then agreed that the persistence of painful motion causing functional loss supported at least the 10% rating (based on §§4.59, 4.40 and 4.45). Panel members agreed a preponderance of objective medical evidence did not exist for a determination of the rating percentage at the time of entry into service. Therefore an EPTS deduction cannot be made. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the right ankle condition, coded 5099-5003-8724.

BOARD FINDINGS: In the matter of the right ankle condition, the panel recommends a disability rating of 20%, coded 5099-5003-8724 IAW VASRD §4.124a. 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	
Right Ankle Failed Brostrom Repair	5099-5003-8724	20%	

2	PD-2017-05999

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

IN REPLY REFER TO,
1850
CORB:003 12 Oct 20

From:	Director, Secretary of the Navy Council of Review Boards To:	
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 22 Feb 20

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 7 October 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 Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.
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