RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01068
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve, E7, Motor Transport Operator, medically separated for “chronic pain, right knee,” with a disability rating of 10%.

CI CONTENTION:  The CI was rated for other conditions by the VA.  The 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 confined to 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 - 20070122	VARD – 20070402	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, R Knee	5099-5003	10%	S/P Arthroscopy for Medial Meniscal Tear, w/
Asymptomatic Scars	5259	10%	20061025	
Right Shoulder Rotator Cuff Tear with Pain	Not Unfitting	Chronic Strain with Joint Cyst, Right Shoulder	5299-5203	10%	20061025	
Exercise Induced Asthma	Not Unfitting	Asthma	6602	60%*	20061025	
Sleep Apnea	Not Unfitting	Sleep Apnea	6847	50%*	20061025	
Depression	Not Unfitting	Major Depressive Disorder	9434	30%*	20061024	
Diabetes	Not Unfitting	Diabetes Mellitus	7913	10%	20061025	
Headaches	Not Unfitting	Migraine Headaches	8100	30%*	20061025	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  100%	
*VARD dated 20071106 rated these deferred conditions and increased combined rating to 100%

ANALYSIS SUMMARY:   

Chronic Pain, Right Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in May 2007 for a torn medial meniscus.  Chondromalacia was noted during the procedure.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  

At the MEB NARSUM examination on 18 September 2006 (5 months before separation), the CI reported his knee improved after surgery, but that he had continued intermittent pain and stiffness.  He had occasional popping, but no giving way.  The physical examination of the right knee demonstrated absence of swelling, warmth, redness and crepitus.  The knee was tender to palpation.  Knee range-of-motion (ROM) was flexion to 125 degrees (normal 140) and extension to 0 degrees (normal).  The examiner noted pain limited motion. 

At the VA Compensation and Pension (C&P) examination performed on 25 October 2006 (4 months before separation), the CI reported daily knee pain lasting up to an hour a day.  He was unable to run, climb, or perform certain movements.  A right knee X-ray taken 5 months post-operatively was normal.  The physical exam of the right knee demonstrated tenderness and crepitus.  ROM was flexion to 140 degrees and extension to 0 degrees.  The examiner noted pain, fatigue, weakness and lack of endurance, and limited motion after repetitive use. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10% coded 5099-5003, (analogous to arthritis, degenerative) citing “slight/frequent” pain using the US Army pain policy.  The VA rated the right knee condition 10% coded 5259, (cartilage semilunar, removal of, symptomatic), citing painful motion.  There was no limitation of motion supporting a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion supporting a 10% rating (based on §4.59) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258).  The Board noted the use of code 5259 by the VA; however, the use of this code would not increase the rating. 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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  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.  

Right Shoulder Rotator Cuff Tear.  The NARSUM recorded physical findings of a non-tender shoulder to palpation and pain limiting ROM.  ROM measurements recorded at the C&P exam, 4 months before separation, were non-compensable.  The available evidence demonstrated one visit in 2005 to primary care related to right shoulder pain.  It was noted that the pain was controlled with medication and rest.  Treatment records for this condition were silent beyond March 2005.  Although the condition was profiled as U2, there was no indication from the record that this condition had a negative impact on duty performance.  

Sleep Apnea.  The NARSUM noted that this condition was diagnosed in the mid-1990s when the CI was in the regular reserves.  He received a continuous positive airway pressure (CPAP) machine from the VA but did not bring the device with him when he mobilized in 2004 and thus did not use if for 2 years.  The examiner recorded “this is a chronic and stable condition.”  The examiner concluded the sleep apnea condition was medically acceptable.  The sleep apnea was profiled P2 without any documented physical or functional impairment/limitation.  The sleep apnea and right shoulder conditions were not implicated in the commander’s statement and were not judged to fail retention standards.   
With regards to the asthma, depression, diabetes, and headache conditions, none were profiled or implicated in the commander’s statement and none were judged to fail retention standards.   All were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation 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 any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the chronic right knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right shoulder rotator cuff tear, exercise-induced asthma, sleep apnea, depression, diabetes and headache conditions, the Board unanimously recommends no change from the PEB determinations 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 20140227, 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 AR20160005842  (PD201401068)

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:

 

Enclosure CF:
( ) DoD PDBR
(  ) OVA