RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03181
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E2, Unit Supply Specialist, medically separated for “bursitis of the left knee” rated 0%.

CI CONTENTION:  The CI requested that all conditions be considered.  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 - 20070813	VARD - 20071219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Bursitis…Left Knee…	5019	0%	Residuals of Left Knee Injury…	5019	10%	20071031	
Reactive Depression	Not Unfitting 	Depression	9435	NSC	20071101	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bursitis of the Left Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in January 2007 when he fell and struck the front of the knee on concrete.  He was initially treated with crutches with improved, but persistent pain.  An MRI in March 2007 showed fluid buildup in the sac (bursa) between the skin and the kneecap; a follow-up study in May 2007 revealed “dramatic resolution” with minimal residual signs of swelling remaining.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “posttraumatic bursitis, pre-patellar, left knee” for PEB adjudication.  The NARSUM was dated 14 June 2007.  He was able to walk without a limp and the range of motion (ROM) was full.  Tenderness was present, but painful motion was not recorded.  Inspection showed the left and right knees without difference.  The previously noted swelling was resolved.  The MEB NARSUM dated 14 June 2007, 2 months prior to separation, noted complaints of left knee pain, an inability to run, and that the CI was limited to walking at his own pace with a slight limp.  There was no need for crutches at the time.  Physical examination revealed no evident limp and normal appearance of the left knee.  There was some tenderness at the front of the knee but no redness, swelling, or heat.  The rest of the examination was unremarkable, and ROM was recorded as “full” (normal 0-140 degrees).  Painful motion was not reported in this examination.  At the VA Compensation and Pension (C&P) evaluation performed on 31 October 2007, 2 months after separation, the CI reported intermittent flare-ups of left knee pain brought on by prolonged standing, running, climbing, or squatting, and treated with Motrin.  He also reported occasional swelling, but denied locking or giving way.  He was a full-time student.  The CI denied using a cane or brace as well as incapacitating episodes.  The physical examination showed normal gait and neurologic examination (strength, reflexes and sensation).  The ROM was recorded for both knees at 0-120 degrees, with pain at the extremes of extension and flexion in the left knee.  There was no ligamentous instability, crepitus, or other abnormalities, but tenderness was present over the left knee.  An X-ray of the left knee was normal.  At the time of the primary care clinic appointment on 9 November 2007 (3 months after separation), the CI reported he had been in a motor vehicle accident on 20 October 2007, 11 days prior to the VA C&P examination, and reinjured the knee.  Left knee pain was rated at 6/10 in severity.  On examination, there was mild swelling and tenderness of the left knee.  ROM was reported as normal.  Later that same day, a different physician noted the left knee had limited range of motion due to pain.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5019 (bursitis), citing no loss of motion.  The VA also used the 5019 code, but rated the left knee condition 10%, citing painful and limited motion, based on the post-separation C&P examination.  The post-separation VA examination was accomplished 11 days after a motor vehicle accident in which the CI re-injured his left knee.  This reduces the probative value of the VA C&P for rating purposes at the time of separation and the MEB examination is used.  The ROM is normal and painful motion was not documented.  The gait was normal.  The Board concluded there was sufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  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.  

Contended PEB Conditions:  Reactive Depression.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended reactive depression condition was not unfitting.  The reactive depression condition was not profiled or implicated in the commander’s statement.  It was judged to meet retention standards.  There was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bursitis of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended reactive depression condition, the Board unanimously recommends no change from the PEB determination 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 20140521, 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), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160013905 (PD201403181)

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