RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01287
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “left iliotibial band syndrome” with a disability rating of 10%.  

CI CONTENTION:  “Left knee still locks, pops, and swells every day.  I have had other injuries happen due to my knee giving out. I have seen a doctor at V.A. for this.”  The applicant’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 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 - 20080221	VARD - 20080630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Iliotibial Band Syndrome…	5314	10%	Iliotibial Band Syndrome, Left Knee	5259	0%	20080414	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a twisting injury to his left knee while deployed to Iraq in August 2006.  Radiographic studies showed a normal left knee, however in May 2007, he underwent a left knee arthroscopy to remove inflamed joint tissue (limited synovectomy).  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  

At the time of the orthopedic NARSUM examination on 9 January 2008, 4 months prior to separation, the CI reported knee pain and a "locking" sensation on the side of his knee.  The examiner noted no joint line tenderness (meniscal sign), but some tenderness to palpation “specifically along the IT (iliotibial) band on the lateral aspect of the leg.”  The gait was normal, and the knee was stable to ligamentous testing.  No pain or crepitus with motion was noted, and the ROM was mildly limited in flexion as recorded in the chart.  Gait and stance were normal and motor exam and muscle tone were normal.  

At the VA Compensation and Pension (C&P) examination on 14 April 2008, performed 1 month before separation, the physical examination showed no evidence of swelling or inflammation; no evidence of instability, locking, or loss of function, and no evidence of pain during active ROM testing.  Gait, posture, stance and balance were normal.  There was “no evidence of sensory or motor impairment.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10% coded 5314 (part of muscle group XIV), citing persistent knee pain following surgery (“rated as moderate”).  The VA rated the left knee condition 0%, coded 5259 (cartilage, semilunar, removal of), citing a noncompensable evaluation.  There was no through and through or deep penetrating wound, with debridement, prolonged infection, or sloughing of soft parts, or intermuscular scarring; or prolonged hospitalization for treatment, or deep muscle scarring for any rating higher than 10% (moderate) under muscle rating IAW VASRD §4.73 and the tenants of §4.55 (principles of combined ratings for muscle injuries) and §4.56 (evaluation of muscle disabilities).  

There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257) for dual rating of the knee.  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).  

Regarding alternative coding analogously to meniscal code 5259, that coding includes painful motion and other “symptoms.”  It is limited to 10% and would offer no benefit to the CI.  There was no evidence of frequent locking with effusions for any higher meniscal rating under code 5258.  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 knee condition. 

BOARD FINDINGS:  In the matter of the knee condition and IAW VASRD §4.73 and §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.  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 20140226, 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 AR20160005885 (PD201401287)

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
( ) DVA