RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXX                BRANCH OF SERVICE:  marine corps
CASE NUMBER:  PD0900706                 SEPARATION DATE:  20050930
BOARD DATE:  20110713


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered individual  (CI)  was  an  active  duty  LCpl/E-3
(0313, Armored Vehicle Crewman)  medically  separated  for  persistent  left
ankle pain.  The CI fractured his left ankle in August  2004  while  he  was
changing a tire.  He was treated, but did not respond adequately to  perform
his required  military  duties  or  meet  physical  fitness  standards.   He
underwent a  Medical  Evaluation  Board  (MEB).   Left  ankle  fracture  was
addressed in the narrative summary (NARSUM) and forwarded  to  the  Physical
Evaluation Board (PEB) on the NAVMED 6100/1.  The PEB found the  left  ankle
condition unfitting, and rated it 0%.  The CI  accepted  the  PEB  findings,
and was medically separated with a 0% disability rating.


CI CONTENTION:   “Ankle  injury  is  still  affecting  my  job  and  or  get
employed.  Also many other conditions  have  been  found  that  are  service
connected.”  In block  14  of  DD  Form  294  the  CI  lists  his  VA  rated
conditions, so a contention for their inclusion in the separation rating  is
therefore implied.


RATING COMPARISON:

|Navy  PEB – dated 20050711      |VA (3 mo. Post Separation) – effective  |
|                                |date 20051001                           |
|Condition                       |Code                                    |


ANALYSIS SUMMARY:

Left Ankle Condition.  This Marine was changing a tire on  18  August  2004.
The tire struck him in the knee, causing two fractures of  the  left  ankle.
Ten days later, he underwent open reduction and internal fixation (ORIF)  of
the ankle fractures.  His postoperative  course  was  unremarkable,  and  he
achieved radiographic healing.  However, he continued to have  pain  in  the
left ankle (primarily medial) which precluded him from doing any running  or
high-impact activities.  He could tolerate elliptical running for  about  15
minutes.  Any more than that would result in left ankle  pain.   Examination
of his left ankle on 27 June 2005  revealed  some  tenderness  to  palpation
(TTP) and mild soft tissue swelling.  X-rays again showed  good  healing  of
the bony ankle  injury.   In  December  2005  (two-and-a-half  months  after
separation) the CI underwent a VA compensation and  pension  (C&P)  exam  at
the Minneapolis VA Medical Center.  The examiner documented left ankle  TTP,
and pain with motion.  Two goniometric range  of  motion  (ROM)  evaluations
were  in  evidence  which  the  Board  used  in  arriving  at   its   rating
recommendation.  Left ankle  ROM  from  both  exams  is  summarized  in  the
following table.
|Left Ankle             |Separation Date: 20050930                     |
|Goniometric ROM        |MEB exam – 20050627   |VA C&P exam – 20051213 |
|                       |(3 mos.               |(2½ mos.               |
|                       |Pre-Separation)       |Post-Separation)       |
|Dorsiflexion  (20⁰ is  |10⁰                   |(unable to perform)    |
|normal)                |                      |                       |
|Plantar Flexion  (45⁰  |40⁰                   |45⁰ (pain at 45⁰)      |
|is normal)             |                      |                       |
|§4.71a Rating          |0%                    |10%                    |
|Comments               |No mention of painful |10% based on limited   |
|                       |motion                |motion                 |

The PEB and VA chose different coding options for the left ankle  condition.
 The PEB coded the ankle 5099-5003 (analogous  to  degenerative  arthritis),
while the VA used diagnostic code 5262  (impairment  of  tibia/fibula,  with
malunion  or  nonunion).   The  Board  carefully  reviewed  all  evidentiary
information available.  The Board determined that  since  the  CI  had  some
limitation of  ankle  motion;  the  most  appropriate  code  would  be  5271
(limited ankle motion).  Normal ankle motion involves 65  degrees  of  joint
excursion, from full dorsiflexion to full plantar flexion.  At  his  VA  C&P
exam,  the  CI  had  45  degrees  of  left  ankle  excursion.    After   due
deliberation, the Board unanimously recommends a disability  rating  of  10%
for the chronic left ankle condition.  It is appropriately  coded  5271  and
meets criteria for the 10% (moderate) rating level, IAW VASRD §4.71a.

Remaining Conditions.  Acne,  gastrointestinal  (GI)  disease,  and  several
other conditions were also found in the Disability Evaluation  System  (DES)
file.  None of them were implicated  in  the  commander’s  statement.   They
were all reviewed by the action officer and considered  by  the  Board.   It
was determined that none  could  be  argued  as  unfitting  and  subject  to
separation rating.  Tinnitus and posttraumatic stress  disorder  were  rated
by the VA, but were not found in the DES file.  The Board does not have  the
authority to render fitness or rating  recommendations  for  any  conditions
not considered by the DES.  The Board therefore has no reasonable basis  for
recommending any additional unfitting conditions for separation rating.


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.  In the matter of  the  left  ankle  condition
(IAW VASRD §4.71a) the Board unanimously recommends a disability  rating  of
10%.  In the matter of  the  acne,  GI  disease,  or  any  other  conditions
eligible for consideration, the Board  unanimously  agrees  that  it  cannot
recommend any findings of unfit for additional rating at separation.


RECOMMENDATION:  The Board therefore recommends  modification  of  the  CI’s
disability and separation determination as detailed below.

|UNFITTING CONDITION                               |VASRD CODE  |RATING  |
|Left Ankle Pain, With Limitation Of Ankle Motion  |5271        |10%     |
|(Moderate)                                        |            |        |
|COMBINED    |10%     |








The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20091130, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.





                                        Deputy Director
                                                                    Physical
Disability Board of Review


MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION
            ICO XXXXX, FORMER USMC, XXX XX XXXX

Ref:   (a) DoDI 6040.44
          (b) PDBR ltr dtd 1 Aug 11

1.  I have reviewed the subject case pursuant to reference (a) and approve
the recommendation of the Physical Disability Board of Review (reference
(b)).

2.  The subject member’s official records are to be corrected to reflect
the following disposition:

      a. Separation from the Naval service due to physical disability rated
at 10 percent (increased from 0 percent) effective 1 October 2005.

3.  Please ensure all necessary actions are taken to implement this
decision and the subject member is notified once those actions are
completed.




                                        Assistant General Counsel
                                     (Manpower & Reserve Affairs)