RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02231
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Fire Support Specialist, medically separated by for “iliotibial band friction syndrome, right knee,” with a disability rating of 10%.  

CI CONTENTION:  The applicant believes that he was given an improper rating for his conditions.  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 - 20071106	VARD - 20080313	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Iliotibial Band Friction Syndrome, Right Knee	5399-5314	10%	Right Knee Iliotibial Band Syndrome	5260	10%	20071221	
Mild Obstructive Sleep Apnea (OSA)	Not Unfitting	Sleep Apnea with Insomnia	6847	50%		
Hiatal Hernia		Hiatal Hernia	7346	0%		
Intermittent Headaches		Chronic Headaches	8199-8100	0%		
Pre-Diabetes		Diabetes Mellitus	7913	NSC		
Right Tensor Fascia Lata Strain and Right Lumbo Sacral Strain Secondary to Iliotibial Band Friction Syndrome		Right Tensor Fascia Lata Strain Associated with Right Knee Iliotibial Band Syndrome	5399-5252	10%		
		Right Lumbosacral Strain Associated with Right Knee Iliotibial Band Syndrome	5237	10%		
Low HDL		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Knee Iliotibial Band Friction Syndrome.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in January 2005 and was associated with running.  Magnetic resonance imaging was consistent with iliotibial band friction syndrome.  There was no surgical indication.    At the time of the orthopedic clinic appointment on 24 August 2007, 5 months prior to separation, the CI reported right knee pain with running, stairs, or prolonged sitting.  On examination he was noted to have full range of motion (ROM) in his knee, stable ligaments, and tenderness over the iliotibial band.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and so he was referred for an MEB.  

At the MEB examination (recorded on DD Form 2807 and 2808) dated 12 September 2007, 4 months prior to separation, the CI reported that his right knee gives out on him and sometimes hurts so bad that he can’t put any weight on it.  Physical exam showed right knee crepitus and painful motion.  The MEB NARSUM performed on 10 October 2007, 3 months prior to separation, indicated that the CI reported that he had been unable to run since January 2007, but could do a 1.5 mile walk at own pace and stand for up to 20 minutes at a time.  On examination there was painful motion and tenderness with no swelling or instability.  The ROM was mildly limited in flexion as recorded in the chart and it was notable that his right knee ROM was identical to his left knee ROM.  At the time of the primary care clinic appointment in November 2007, 2 months prior to separation, the CI reported right knee pain.  On examination he was noted to have tenderness with full pain-free ROM in his knee with normal gait.  

At the VA Compensation and Pension (C&P) examination on 21 December 2007, performed a month before separation, the CI reported that his knee pain was aggravated by walking greater than 30 minutes or walking up stairs.  He also reported that his knee pain limited him from standing more than 30 minutes or driving more than 60 minutes.  Physical exam showed even gait without use of aides or braces, no instability, tenderness, painful motion, swelling, abnormal movement or guarding of movement.  The ROM was mildly limited in flexion as recorded in the chart and again it was notable that his right knee ROM was identical to his left knee ROM.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded analogous to 5314 (muscle group XIV), citing fatigue-pain (10% is the “moderate” rating criteria).  The VA rated the right knee condition 10%, coded 5260 (limitation of leg flexion), citing Service records and leg functional loss due to pain, painful motion, and slightly limited motion due to a clinical diagnosis.  There was no through and through or deep penetrating muscle 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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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), to support a rating under the respective codes.  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 is therefore no VASRD §4.73 or §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 knee 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 low HDL, mild obstructive sleep apnea, hiatal hernia, headaches, pre-diabetes, right tensor fascia lata strain (hip) and right lumbosacral strain (back) conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The low HDL, mild obstructive sleep apnea, hiatal hernia, headaches, pre-diabetes, right tensor fascia lata strain, and right lumbosacral strain conditions were not profiled and all were considered and addressed by the MEB and ultimately judged to not fall below the Army’s retention standards.  Although the commander mentioned the CI’s hip and back in his statement to the PEB, he gave no indication that they significantly interfered with satisfactory duty performance.  All were reviewed and considered by the Board.  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 right knee condition and IAW VASRD §4.73 and §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended low HDL, mild obstructive sleep apnea, hiatal hernia, headaches, pre-diabetes, right tensor fascia lata strain and right lumbosacral strain 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 20140517, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

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 XXXXXXXXXXXXXXXXXXXX, AR20160007482 (PD201402231)

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