RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01007
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090509

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Patriot Operator/Maintainer, medically separated for “right leg limitation of extension” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for all conditions.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20090129	VARD - 20090608	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Leg Limitation of Extension	5261	10%	Osteoarthritis and S/P Torn Tendons and Ligaments Surgery, Right Knee 	5260-5010	10%	20081227	
			Limitation of Extension, Right Knee	5299-5261	10%	20081227	
Degenerative Disc Disease	Not Unfitting	Degenerative Arthritis, Thoracolumbar Spine	5242	10%	20081227	
Asthma	Not Unfitting	Asthma	6602	0%	20081227	
Hypertension	Not Unfitting 	Hypertension	7101	10%	20081227	
Sleep Disturbance	Not Unfitting	Sleep Apnea	6847	50%	20081227	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Right Leg Limitation of Extension.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in October 2007, when she injured her anterior cruciate ligament (ACL) and meniscus on an air assault course.  In February 2008, she underwent a right ACL reconstruction and meniscal repair.  She was issued a P3 profile and recommended for a Military Occupational Specialty/Medical Retention Board (MMRB).  The MMRB found her fit for duty in her military occupational specialty.  Despite the MMRB recommendation and extensive physical therapy, she continued to have a 10 degree flexion contracture of her right leg and pain when she walked.  Consequently, the knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and she was referred for an MEB.  The MEB forwarded “right knee arthrofibrosis and flexion contracture following ACL reconstruction” for PEB adjudication.  At the MEB NARSUM on 30 October 2008 (6 months before separation), the examiner noted an asymmetric gait due to a noticeable flexion contracture in her right knee.  Her surgical incisions were mature and well healed, and her right quadriceps had slight atrophy.  Right knee range of motion (ROM) and strength were limited with pain at terminal ROM.  There was no crepitus and examination tests for ligamentous instability and meniscus pathology were negative.  At the VA Compensation and Pension (C&P) examination on 27 December 2008, performed 4 months before separation, the CI reported weakness, swelling, give-way, lack of endurance, locking and fatigability.  She reported constant burning and sharp (10 of 10) pain from the ankles to the calf.  Examination revealed weakness, tenderness and guarding, and tests for ligamentous instability and meniscus pathology were negative.  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below. 

Right Knee ROM
(Degrees)	MEB ~6 Mos. Pre-Sep	VA C&P ~4 Mos. Pre-Sep	
Flexion (140 Normal)	82, 84, 85	85	
Extension (0 Normal)	11, 11, 11	5	
Comment	painful motion, asymmetric gait	weakness, tenderness and guarding,	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10% coded 5261 (leg, limitation of extension), citing limitation of extension and functional loss.  The VA also rated the right knee condition 10%, but coded 5299-5261 (analogous to limitation of extension), citing limitation of extension.  The VA additionally rated the right knee surgical osteoarthritis and torn tendons and ligaments surgery at 10% under code 5260-5010 (analogous to arthritis, due to trauma).  

The VA examination revealed a right knee extension limitation, and the MEB examination recorded right knee extension limited to 11 degrees (following repetitive motion), supporting the 10% rating (code 5261) adjudicated by the PEB.  There was no limitation of flexion that supported a rating under the VASRD diagnostic code for limitation of flexion (5260).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under the respective codes.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  No additional functional limitation was evidenced by the examinations.  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 knee condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that degenerative disc disease (DDD), asthma, hypertension and sleep disturbance were not unfitting conditions.  

The DDD condition was profiled along with sciatica and knees, and the MEB cited the DDD as not meeting retention standards.  The commander’s statement stated the CI was not physically able to perform the duties of her MOS or conduct tasks required for field operations as well as tasks necessary for training soldiers under her authority.  However, the back condition was not specifically identified as an impediment to duty performance.  The evidence of record including her performance evaluations showed she had performed well even with the back pain.  An established principle for fitness determinations is that they are performance-based, and there was no direct evidence in this case which noted any compromise in duty performance linked to the DDD.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the DDD condition as well as the asthma, hypertension, and sleep disturbance conditions, and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended DDD, asthma, hypertension and sleep disturbance conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160009947 (PD201401007)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review
(DoD PDBR) recommendation and record of proceedings pertaining to the subject
individual. Under the authority of Title 10, United States Code, section 1554a, I accept
the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA