RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03579
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Motor Transport Operator, medically separated for “posttraumatic degenerative changes, left knee, status post shrapnel injury, ” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention in their application.  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:  

SERVOCE PEB - 20050119	VARD -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Degenerative Changes, Left Knee, Status Post Shrapnel Injury	5010	10%	Left Knee Prepatellar Bursitis, S/P Shrapnel Injury	5299-5260	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee.  The CI received an IED driven shrapnel injury to her left knee in September 2003.  Initial X-rays did not reveal boney involvement such as fracture or dislocation.  The resulting wound was locally debrided and left to heal without primary closure.  Despite physical therapy and rehabilitation, she was left with persistent left knee pain.  She was permanently profiled on 22 October 2004 with the listed diagnosis of left knee pain status post shrapnel injury.  Repeat X-rays performed on 15 November 2004 were reported as normal.  An Orthopedic evaluation on 15 November (a day prior to the NARSUM examination) noted that she ‘may also have post-traumatic degenerative changes’ in the left knee.  At the NARSUM examination (16 November 2004; 3 months prior to separation), the CI reported pain and swelling in her left knee.  Her physical examination revealed tenderness and painful limited motion of the left knee.  There was minimal effusion present as well as decreased sensation below the left knee wound.  The diagnosis was left knee pain with a pain assessment of “slight” and “constant.”  The service treatment records utilized by the VA for rating purposes represented a Service period from 28 February 2002 through 19 January 2005.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5010 (traumatic arthritis) citing degenerative changes, whereas the VA assigned a 10% rating under the analogous code of 5299-5260 (limitation of leg flexion) citing painful motion and tenderness.  Board members first acknowledged that significant clinical disparity with regards to ROM did exist between the orthopedic clinical encounter and MEB examination which were dated a day apart.  Members deliberated and concluded that despite the obvious variance, both exams would not support any VASRD §4.71a impairment rating greater than the PEB’s current 10% level.  Additionally, the action officer opined and Board members agreed that the examination detail was much more comprehensive at the MEB evaluation and clearly, the evidence of painful motion was justified under VASRD §4.59.  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.

BOARD FINDINGS:  In the matter of the left 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 20131025, 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, AR20160008661 (PD2014-03579)

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.

Enclosure

CF:
( ) DoD PDBR
( ) DVA