Author: JOHN J. D'ORAZIO
Last saved by: julie.raveau
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xx	CASE:  PD1201674
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20130515
SEPARATION DATE:  20020225

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty FN/E-3 (NEC/Undesignated Fireman) medically separated for a right ankle condition.  He had a history of right ankle pain with the initial injury occurring in August 1999 while playing basketball.  He presented to the orthopedic clinic because of continued pain.  Despite surgical intervention he could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards.  He was placed on multiple limited duties (totaling 16 months) and referred for a Medical Evaluation Board (MEB).  The right ankle condition, characterized as “recalcitrant right ankle pain, status post right talar oats procedure, right peroneal tenosynovitis, right ankle arthrofibrosis with approximately 5 degree loss of dorsi, right subtalar arthrofibrosis with approximately 5 degree loss of in, right ankle post-traumatic arthritis, bilateral pes planovalgus deformities,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4D.  No other conditions were submitted by the MEB.  The PEB adjudicated “loss of right ankle motion, approximately 5 degrees of dorsiflexion” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category II.  The CI made no appeals, and was medically separated with a 10% disability rating.

CI CONTENTION:  “I have constant day to day pains that limits me from a lot of day to day activities.  I have times where it hurts to walk.  Which includes my ankle & my knees that bothers me daily.  Having the pain hit me at the same time is a real slow down.  That is my knees & ankle at the same time.  I still hold a lot of regrets for this injury because I planned on retiring from the Navy & me getting hurt, having multiple surgeries ended my military career.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting ankle condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20020222 | VA - (15 Mos. Pre/Post-Separation)  *
Condition | Code | Rating | Condition | Code | Rating | Exam
Loss Of Right Ankle Motion, Approx. 5 Degrees of Dorsiflexion | 5024-5003 | 10% | Right Ankle Fracture Postoperative, with residuals of Symptomatic Arthrosis | 5284 | 10% | 20030510

Recalcitrant Right Ankle Pain, S/P  Right Talar
Osteocartilaginous Autograft Transfer
Procedure, S/ P Right Ankle Arthroscopy, S/ P Right Peroneal Tendon Debridement

Category II

Loss Of Right Subtalar Joint Motion, Approx. 5 Degrees of Inversion And 5 Degrees of Eversion | Category II | | | |
Right Ankle Post-Traumatic Arthritis | Category II | | | |
Right Peroneal Tenosynovitis | Category II | | | |
No Additional MEB/PEB Entries | Other x 5 | 20030510
Combined:  10% | Combined:  10%
Derived from VA Rating Decision (VARD) dated 20030621 (most proximate to date of separation [DOS]).   ** VA Exam is more than 12 mos after DOS but compensation is date after separation.

ANALYSIS SUMMARY:  

Right Ankle Condition.  The MEB examiner recorded the CI’s history of right ankle pain associated with an injury he sustained while on active duty.  The injury was initially treated as a strain with physical therapy.  In August 1999 the CI underwent right ankle scope that revealed evidence of an anterolateral osteochondral defect, which was treated.  He continued to have pain in his ankle joint, and on 11 April 2000 the CI underwent a right ankle talar surgical procedure (bone graft from knee) with some improvement; however, he was unable to run.  On 9 November 2000 for continued ankle pain, he underwent a third arthroscopy surgery which revealed only some arthritis and tendinitis.  Area of the bone graft was healed.  Orthopedic clinic follow up visit, approximately 5 months prior to separation recorded right ankle range-of-motion (ROM) dorsiflexion/plantar flexion of 5/35 degrees with a normal motor exam (normal 20/45 degrees).  Orthopedic examination, 3 months prior to separation recorded tenderness in right foot, normal pulses and capillary refill, normal sensation to plantar and dorsal surfaces, normal motor strength and ROM dorsiflexion to 10 degrees, plantar flexion of 15 degrees and inversion of 15 with eversion of 20 degrees.  Radiographs of the right ankle in May 2003, a year after separation demonstrated surgical hardware devices were in place, and no fractures or acute abnormality noted.  At the MEB narrative summary (NARSUM) evaluation on 12 December 2001, 3 months prior to separation, physical examination revealed a ROM of approximately 0 degrees of dorsiflexion, 35 degrees of plantar flexion at the ankle with pain the limiting factor.  Gait was antalgic without reported use of a cane.  Pain was noted over the anterolateral aspect of the right ankle joint.  Magnetic resonance imaging (MRI) referenced recorded bony areas to be well healed with slight arthritis.  At the VA Compensation and Pension (C&P) evaluation, 14 months after separation, the CI reported discomfort in the right ankle region with ambulation.  Physical examination recorded normal gait, absence of foot deformity, or evidence of weight bearing abnormality.  Pain was present on dorsiflexion at 10 degrees and on plantar flexion at 25 degrees without further limitation by fatigue or weakness.  Sensation, reflexes, and motor examinations were normal.

The PEB rated the condition at 10% coded analogously 5024-5003 for (tenosynovitis with pain).  The VA rated the condition 10% coded 5284, moderate symptoms of foot injury.  A higher rating of 20% under the 5003 code requires occasional incapacitating exacerbations involving two or more joints not supported by the record of evidence.  The Board considered a rating under the 5284 and noted a higher rating of 20% required moderately severe symptoms of foot injury.  Careful review of the records in evidence demonstrated no evidence of muscle atrophy, neuropathy, diminished blood flow to the right foot or loss of sensation resulting in functional impairment, no deformity, no ligamentous instability, no evidence of non-healing; the MRI showed that bones were healed, there was moderate degree of decrease ROM (see below), and gait was considered antalgic requiring no assistance and normal gait at the C&P that would support a higher rating.  The Board next considered rating the condition under 5271 limitation of motion code, the Board opined that the preponderance of evidence documented in the treatment records supports a moderate degree of ROM.  The Board agreed the evidence could not support the application of VASRD §4.40 (Functional loss) since there was no evidence of muscle weakness or fatigue in the records at hand.  There is no VASRD pathway to a rating higher than the minimal compensable rating.  The Board opined that Category II conditions, the loss of right subtalar joint motion; recalcitrant right ankle pain status post right talar osteocartliaginous autograft transfer procedure, status post right ankle arthroscopy, status post right peroneal tendon debridement; right ankle post traumatic arthritis and right peroneal tenosynovitis were all integral components of the right ankle pathology and could not be recommended for additional rating IAW VASRD 4.14 (Avoidance of pyramiding).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right ankle condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION | VASRD CODE | RATING
Loss of Right Ankle Motion | 5024-5003 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120829, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	xx
	President
	Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW 
                                        BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
          (b) CORB ltr dtd 19 Aug 13

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandum, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- former USMC    
- former USN
- former USMC
- former USN 
- former USMC
- former USN 
- former USN
- former USMC
- former USN

						xx
	     					  Assistant General Counsel
						     (Manpower & Reserve Affairs)

PD1201674