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AF | PDBR | CY2012 | PD2012 01677
Original file (PD2012 01677.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201677
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20130521
SEPARATION DATE: 20020331


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-1 (99000/USMC Recruit) medically separated for left ankle fracture. On training day number one in November 2001, as a new USMC recruit, he sustained a trimalleolar fracture of the left ankle while climbing ropes during training and underwent surgery for the ankle fracture. The injury was deemed to be inconsistent with continued service and unlikely to be expeditiously rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards. He was referred for a Medical Evaluation Board (MEB). The left ankle condition, characterized as “left ankle trimalleolar fracture, s/p open reduction internal fixation” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated “left ankle trimalleolar fracture” as unfitting, rated 20%. The CI made no appeals, and was medically separated.


CI CONTENTION: The application states simply, “I shattered my left ankle and the Dr placed steel plates to replace it. The ankle has casued me pain while performing activities such as standing, walking or daily work activity.”


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 left 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 20020213
 VA – 5 wks. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Left Ankle Trimalleolar Fracture
 5262 20% Fracture, left Ankle, Surgical Repair with Residual Scar 5271 10% 20020222
No Additional MEB/PEB Entries
 Other x 0 20020222
Combined: 20%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 20726 (most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on severity at the time of separation.

Left Ankle Trimalleolar Fracture. The CI sustained a trimalleolar fracture of the left ankle on 19 November 2001 in a 15 foot fall while performing a rope climb early in basic training. He underwent surgical open reduction with internal fixation of the fractures the next day. Since full recovery enabling return to basic training was not anticipated, an MEB was initiated. The MEB narrative summary (NARSUM) dictated a month after surgery and 3 months prior to separation, noted satisfactory post-operative recovery. The CI was still in a short leg cast and using crutches. X-rays demonstrated the left ankle trimalleolar fracture with good fixation of the fibula with plate and one distal fragment screw as well as medial malleolus fracture with two screws. There was good alignment and good reconstitution of the joint line. The orthopedic surgeon recommended advancing weight bearing from partial to full in the following weeks as well as physical therapy to improve strength and range-of-motion (ROM). An orthopedic surgery follow up evaluation on 28 January 2002 recorded the CI was doing well and walking on the left ankle. On examination, the left ankle was “healed with excellent functional ROM.” The VA Compensation and Pension (C&P) examination on 22 February 2002, 5 weeks prior to separation. The CI described continued improvement since surgery 3 months prior to. At the time of the C&P exam, the CI described his left ankle condition as “fine.” He was able to walk fairly well, without difficulties, however he had some aching discomfort during the night and with cold weather. Physical examination revealed healed surgical scars. The CI had active movement of the ankle without evidence of intra-articular crepitation and no obvious effusion. There was slight swelling of the ankle related to the recent surgery. The CI was able to get up on the toes of his foot without difficulty as well as walk with weight on his heels. Ankle motion was still limited on the left but apparently improving. ROM of the left ankle evidenced dorsiflexion of 15 degrees (normal 20) and plantar flexion of 45 degrees (normal 45) (uninjured right ankle of 25 and 75 degrees). Both of these measurements were done actively and passively without pain. There was decreased subtalar motion of the left ankle (inversion 0 degrees, eversion 10 degrees) without pain. There was no evidence of muscle atrophy (calf measurements 38 cm bilaterally), instability or incoordination. Weakness and fatigability were considered minor issues while pain was not a significant factor.

The Board directs attention to its rating recommendation based on the above evidence. The PEB adjudicated the left ankle condition under code 5262 (impairment of tibia and fibula) and assigned a 20% rating for moderate ankle disability. The VA assigned a 10% disability rating under code 5271 (limitation of motion of the ankle) for moderate limitation of motion. At the time of the C&P examination the left ankle dorsiflexion and plantar flexion were mildly limited compared to normal although the uninjured right ankle demonstrated motion exceeding typical normal range. The orthopedic surgeon noted good functional range of motion. All Board members agreed the limitation of motion was no more than moderate supporting the 10% rating adjudicated by the VA. The PEB adjudicated its 20% rating for moderate impairment of the fibula and tibia (5262) based on evidence one month after surgery. There was no nonunion to assign a 40% rating under this code. X-rays showed good alignment without evidence of malunion however the Board agreed analogously rating under this code was a reasonable approach considering the nature of the original injury. The C&P examination more proximate to the time of separation evidenced continued improvement since the time of the MEB NARSUM. All members agreed that the C&P examination reflected slight ankle disability (10%) and that there was no evidence for more than moderate ankle disability (20%) under the 5262 code. The Board also considered whether a higher rating was supported under other diagnostic code options. There was no ankylosis to support a minimum rating under the respective code (5270). 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 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 left 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
Left Ankle Trimalleolar Fracture
 5262 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120830, 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 15 Jul 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 USMC
- former USMC
 - former USN
- former USN
- former USN


                                                      xx
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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