RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01334
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20090528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Munitions Systems Craftsman, medically separated for “chronic right knee pain” and “social phobia,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI requests the Board consider 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 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 – 20090409	VARD - 20130814	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5003	10%	Chronic Knee Pain	5003-5260	10%	20130228	
Social Phobia	9499-9413	10%	Generalized Anxiety and Social Phobia Disorder	9413	50%	20130228	
Asthma	Category II	No VA Placement	
Obstructive Sleep Apnea	Category II	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain began in Germany in 2001 while hiking.  Neuroimaging in 2007 showed right medial and lateral meniscus tears.  Orthopedics performed surgical repair in January 2008 and again in March 2008.  The CI continued to have duty limiting knee pain, not allowing him to kneel, climb, run or walk long distances.  He was not able to return to full activity despite surgery and other treatments.  He continued to have pain and stiffness.  Duty tasks remained limited.  At the VA Compensation and Pension (C&P) examination performed 5 years after separation, the CI reported constant back pain exacerbated by exercise.  He reported the and ability to walk for 2 miles on a flat smooth surface and use an exercise bike for about 15 minutes.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain 10% coded 5003.  The VA rated the knee pain 10% coded 5003-5260 (leg, limitation of flexion due to degenerative arthritis), based on the VA C&P examination 5 years after separation, citing 4.59 functional loss due to painful motion.  The commander noted he was able to perform his primary duties but was unable to perform many additional duties.  His physical activity was limited by no lifting, extended physical work or prolonged walking.  The Board agreed that there was sufficient evidence of painful motion to warrant a 10% rating for the right knee IAW VASRD §4.59 (painful motion) and §4.45 (the joints).  Other pathways to a higher rating were considered, but there was no subluxation, ankyloses,  objective instability, and no limitation of motion sufficient to warrant any rating higher than 10% for the knee.  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 the chronic right knee pain condition.  

Social Phobia.  According to STR and the MEB NARSUM addendum, the CI’s social phobia condition began at an unknown time.  He presented to mental health in February 2007 for evaluation of anxiety, social phobia, self confidence and communication difficulty.  He attended counseling twice a month from February 2007-March 2008 and received medication management with an anti-depression medication by a psychiatrist.  He had a good response and stopped medication.  He returned in October 2008 and reported anxiety and insomnia had returned.  He had excessive worry regarding work, family and personal issues.  It make it harder for him to communicate and interact in social situations.  He also expressed concerns about attention deficit hyperactivity disorder.  

The MEB NARSUM examination on 8 January 2009, 5 months prior to separation, noted complaints of chronic anxiety.  He was taking a sleep aid as needed and an anti-stimulant  medication.  There was no history of hospitalization or suicide attempts.  Mental status examination (MSE) showed a mildly constricted affect.  He did not have significant indications of a personality disorder.  A diagnosis of social phobia and ADHD were rendered with a Global Assessment of Functioning (GAf) score of 75 (mild symptoms, transient impairment.)  the examiner noted that social/industrial impairment was mild.  At the VA Compensation and Pension (C&P) examination performed 5 years after separation, the CI reported continued anxiety, difficulty finding employment, and treatment with counseling and medication at times.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the social phobia condition 10% coded 9499-9413 (anxiety disorder NOS).  The VA rated the generalized anxiety and social phobia condition 50% coded 9413 based on the VA C&P examination 5 years after separation, citing anxiety, difficulty adapting to stressful circumstances and difficulty establishing and maintain effective work and social relationships.  Application of VASRD §4.129 is considered by the Board for all cases of service connected psychiatric conditions resulting in separation; but all members agreed that the “highly stressful event” requisite for §4.129 was not satisfied in this case.  

The Board then considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication.”  A 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The NARSUM examiner noted his symptoms responded to treatment but recurred when counseling and medication were discontinued.  His condition depended on his level of involvement with treatment.  There was no evidence of symptoms that met criteria for a higher disability rating.  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 the social phobia condition.  

Contended PEB Conditions .  The Board’s main charge is to assess the fairness of the PEB’s determination that asthma and obstructive sleep apnea were not unfitting.  The PEB adjudicated these conditions as Category II, acknowledging they are conditions that could be unfitting but there was no evidence they were currently compensable or ratable.  Both conditions appeared to be stable: and he did not require any medications for asthma and the BiPAP controlled most of his sleep apnea symptoms.  The asthma and sleep apnea conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  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 the any of the contended conditions and so no additional disability ratings are recommended.

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BOARD FINDINGS:  In the matter of the social phobia condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication.  In the matter of the contended asthma and obstructive sleep apnea 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 20140301, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01334.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings