RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02975
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20020601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (JOB [Multichannel Transmission Systems Operator) medically separated for right lower extremity pain, rated at 0%. 

CI CONTENTION:  The CI contend for a back condition that was not evaluated on the MEB or PEB however he is getting disability compensation from the VA.  The applicant’s complete submission, with attachments, 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 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 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:  
IPEB - Dated 20020326	VA* - (~3 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Lower Extremity Pain	5099-5003	0%	Right Knee Strain	5257	0%	20020828	
Other MEB/PEB Conditions x 0 	Other x 2	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20021023 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY: 

Right Knee Condition.  The service treatment record (STR) documents knee complaints beginning in 1999.  At the 23 April 2001 orthopedic surgery encounter the CI complained of right knee pain with ambulation, prolonged sitting, and going up stairs.  The physical exam revealed tenderness at the proximal, anterolateral, right knee.  There was no effusion (fluid collection) and the patellar apprehension (apprehension or pain on quadriceps contraction with patella displaced) test was negative.  There was no evidence of ligamentous laxity as the Lachman’s (assesses integrity of anterior cruciate ligament) and drawer (assesses integrity of anterior and posterior cruciate ligaments) tests were negative.  Range-of-motion (ROM) was 0 to 130 degrees.  The right knee X-ray was within normal limits (WNL) except for decreased bone density of the proximal, medial fibular head.  The impression listed right leg pain concerning of proximal fibular lesion versus superficial peroneal nerve entrapment.  The 8 May 2001 Physical Medicine and Rehabilitation (PM&R) electodiagnostic studies were normal.  The conclusions documented no electrodiagnostic evidence of right lower extremity compressive neuropathy (injury or irritation of a peripheral nerve) or radiculopathy (irritation or injury of a nerve root).  The 22 June 2001 orthopedic surgery encounter reported the MRI showed no fascial herniation or peroneal nerve entrapment or inflammation.  At the 6 November 2001 orthopedic surgery encounter the CI complained of right knee and tibial pain with exertion.  Pain was present at rest and worse with walking.  The CI reported “popping” but no “locking.”  The right knee exam revealed mild tenderness over the patella with crepitus (grating sound or sensation).  There was full ROM and no swelling, effusion, or ligamentous instability.  In the narrative summary (NARSUM) by orthopedic surgery, the CI complained of eighteen months of right knee pain.  He reported constant 5 to 6/10 pain that was exacerbated by activity and cold weather and relieved with non-weight bearing and rest.  The CI was able to lift his maximal amount of weight without difficulty.  He had no limitations in the amount he could walk, with pain, but was unable to run at all.  Previous treatments included anti-inflammatory medications, activity modification, and physical therapy.  The examiner cited the physical exam performed six months before separation. The exam revealed the CI had a normal gait and normal and equal lower extremity limb circumference.  It documented full ROM of all joints of the lower extremities.  The lower extremity exam revealed normal motor strength (5/5), sensation, and deep tendon reflexes without evidence of clonus or other neurologic abnormality.  The X-rays and MRI were reported as normal.  The diagnosis listed right-sided knee and proximal tibia pain of unknown etiology.  The pain was characterized as slight in severity and occasional in frequency.  In the compensation and pension (C&P) exam, three months after separation, the CI complained of chronic right knee pain since 2000.  He reported onset of the condition due to running exercises during physical training.  The CI reported treatment with ice packs and stretching exercises and denied prosthetic implants.  Under symptoms, the exam documented “He states his condition does require bed rest or treatment by a physician.”  The physical exam revealed a normal posture and gait without any device in order to ambulate.  Leg lengths were equal and the feet showed no sign of abnormal weight bearing.  McMurray (assesses integrity of menisci) and drawer tests were negative.  The documented bilateral knee ROM was flexion of 140 and extension of 0 degrees with pain.  Lower extremity motor function, sensory function, and reflexes (2+) were normal.  The diagnosis listed right knee strain with chronic pain.  The 29 August 2002 right knee X-ray was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The Informal PEB, 2 months before separation, rated the right knee condition at 0% (VA code 5099-5003; rating by analogy, degenerative arthritis).  The PEB cited slight/occasional pain rated with application of the USAPDA pain policy.  The VA rating decision (VARD), citing the C&P exam 3 months after separation, rated the right knee condition at 0% (5257; knee, other impairment of).  The VARD cited pain, full ROM, and normal X-ray findings, gait, motor, and sensory functions.  There was no instability, prosthetic implant, or physician directed bed rest.  The MEB and C&P exams did not demonstrate limitation of motion to support a minimum rating under VA codes for limitation of flexion or extension (5260, 5261).  There was no instability, dislocated meniscus, or removed meniscus to support minimum ratings under the respective codes (5257, 5258, 5259).  Board members agreed that there was sufficient evidence of painful motion (§4.59) prior to separation, as well objective exam findings, to support a 10% rating under 5099-5260.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy AR 635-40 DoDI 1332.39 for rating the right knee condition was operant in this case and the condition was adjudicated independently of that policy/instruction by this Board.  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5260 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Right Lower Extremity Pain	5099-5260	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160005496, 

Dear 

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board1s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical
Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, 

Sincerely,

Enclosure