RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02151
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic pain, left leg and knee,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20090219	VARD - 20080528	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Leg and Knee	5099-5003	10%	Chronic Left Knee Pain, Residual of Shrapnel Injury	5260	10%	20070626	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Leg and Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was exposed to a rocket-propelled grenade (RPG) blast, which led to implantation of shrapnel into his left knee and leg.  His initial surgery was for wound debridement and removal of foreign body.  Post-surgical rehabilitation did not resolve his persistent left knee pain nor result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “osteoarthrosis of the left knee status post micro-fracture with continued knee pain” for PEB adjudication.  At the VA Compensation and Pension (C&P) examination, 26 June 2007, 7 months prior to separation, the CI reported pain and swelling about the left knee with painful flare-ups occurring 1-2 times per week with a duration of less than 30 minutes.  His physical examination (PE) revealed the wearing of a hinged knee brace and he walked with a mildly altered gait.  His left knee range of motion (ROM) was near normal with pain.  The examiner noted the absence of ligament instability.  Tenderness was present.  At the MEB narrative summary (NARSUM), (conducted 1 week after the VA C&P), the CI endorsed continued left knee pain resulting in the inability to run, ruck, jump, or march.  All clinical parameters of the knee focused PE were normal excepting tenderness about the left knee.  His pain was assessed as ‘slight’ and ‘occasional’.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 10% analogously coded 5299-5003 (degenerative arthritis) citing application of the Army Pain Policy and listing the rated pain as ‘slight/constant”.  The VA also rated the condition 10% coded 5260 (limitation of flexion) based on the C&P examination, citing painful limited motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, the consistency of a stable knee with persistent tenderness with functional loss clearly supported a 10% rating (based on §4.40 and §4.45).  It was agreed that frequent locking of the knee due to dislocated semilunar cartilage was not present, and therefore a 20% rating was not justified under the 5258 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 left leg and knee condition.  

BOARD FINDINGS:  In the matter of the left leg and knee 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.  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 20140516, 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 XXXXXXXXXXXXXXXXXXXXX AR20160013533 (PD201402151)

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