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AF | PDBR | CY2012 | PD2012 01155
Original file (PD2012 01155.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201155 
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130523
SEPARATION DATE: 20030827


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty petty officer 1st class/E-6 (BU1, Builder) medically separated for left ankle synovitis. His ankle pain began in 1997. In August 2002, he underwent arthroscopic synovectomy with no relief in pain. The condition could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards. He was placed on limited duty [LIMDU] and referred for a Medical Evaluation Board (MEB). Two left ankle conditions, characterized as “chronic ankle pain, left” and “synovitis of the left ankle,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated the “synovitis of the left ankle” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The chronic left a nkle pain was found to be c ategory II , related to and contributing to th e unfitting synovitis condition . The PEB added a hepatitis C condition as category III , not separately unfitting and not contributing to the unfitting condition. The CI made no appeals, and was medically separated with a 10% disability rating.


CI’s CONTENTION: “I meet the qualifications for and am requesting a review by the PDBR of my disability rating determination at separation.”


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 determinations for the two left ankle conditions are addressed below. The hepatitis C condition was not specifically requested by the CI, and will not be adjudicated by the Board. No other conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in his application, or otherwise outside the Board’s scope of review, may be eligible for future consideration by the Board for Correction of Naval Records.


RATING COMPARISON:

Navy PEB – dated 20030319
 VA – (2 mos. Pre -Separation)
Condition
 Code Rating Condition Code Rating Exam
Synovitis of Left Ankle
 5020-5003 10% Left Ankle Sprain 5271 10% 20030621
Chronic Left Ankle Pain
 Category II
Hepatitis C
 Category III Hepatitis C 7354 10% 20030621
No Additional MEB/PEB Entries
 Other x 7 20030621
Combined: 10%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 31023 ( most proximate to date of separation )

ANALYSIS SUMMARY:

Left Ankle Synovitis. In 1997, the CI developed pain and swelling in his left ankle. There was no history of any specific injury or trauma. Several different treatment options were tried, including physical therapy (PT), ankle brace, orthotics, and arthroscopic surgery. In spite of treatment, his ankle pain persisted and a MEB was initiated. The MEB narrative summary (NARSUM) is dated 22 November 2002. At that evaluation, the CI reported left ankle pain, but denied any ankle instability or locking. Physical examination of the left ankle revealed mild swelling, and some tenderness to palpation (TTP). There was no erythema (redness) or ecchymosis (bruising). Motor strength was normal, and no pain was elicited with resisted muscle contraction. Neurovascular status was intact. The CI’s medial, longitudinal arch was noted to be exaggerated. The metatarsal declination angle was also elevated, consistent with a supinated foot structure.

On 21 June 2003, the CI had a VA compensation and pension (C&P) examination, 2 months before separation from service. At that exam, left ankle range of motion (ROM) was full, but it was painful. The CI’s gait was described as “guarded.” X-rays were normal. The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.
Left Ankle ROM
 PCC ~ 13 mos . Pre-Sep
 (20020703) 		Ortho ~ 11 mos . Pre-Sep
 (20020911) 		VA C&P ~ 2 mos . Pre-Sep
 (200 30621 )
Dorsiflexion (20 ⁰ is n ormal)
 15 ⁰ 20 ⁰ 20 ⁰
Plantar Flexion (45 ⁰ is normal )
 60 ⁰ 30 ⁰ 45 ⁰
Comment
 No Swelling No Swelling Painful motion
§4.71a Rating
 10 % * 10 % 10 % *
*10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion)

The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The Navy PEB and the VA chose different coding options for the unfitting left ankle condition, but both assigned a disability rating of 10%. The ROM evaluation performed on 21 June 2003 was just 2 months prior to separation, and therefore has significant probative value. At that exam, the CI’s left ankle ROM was normal, and the ankle condition was essentially non-compensable based solely on VASRD §4.71a codes for the ankle (5270 through 5274). However; IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint. The Board tried to find a path to a rating higher than 10%, using other codes which could be applied to the left ankle synovitis. The other VASRD codes that were considered did not result in a higher rating, since the record did not show evidence of a significantly disabling joint abnormality which would justify a rating higher than 10%. 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 left ankle synovitis.

Additional PEB Condition. Chronic left ankle pain was adjudicated by the PEB as category II (related to and contributing to the unfitting ITBS condition). The Board determined that this condition was indeed related to the unfitting ankle synovitis, and did not constitute a separately unfitting condition for disability rating purposes. After due deliberation, and IAW VASRD §4.14 (Avoidance of pyramiding), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the “chronic ankle pain, left.”


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 Left ankle synovitis and IAW VASRD §4.40, §4.45, §4.59, and §4.71a; the Board unanimously recommends no change in the PEB adjudication. In the matter of the chronic left ankle pain and IAW VASRD §4.14, the Board unanimously recommends no change in the PEB adjudication as category II. 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
Synovitis of Left Ankle
 5020-5003 10%
COMBINED
 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120614, 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)


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