RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00017
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20031229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Medical Lab Journeyman, medically separated for “post infectious synovitis/arthritis” with a disability rating of 20%.  

CI CONTENTION:  “Please consider all conditions.”

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:  

IPEB - Dated 20031023	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Infectious Synovitis…	5008-5002	20%	Post-Infectious … Right Knee	5257-5003	10%	STR	
Alcohol Dependence	Not Unfitting 	No VA Placement	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 13 	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20040526 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Post-Infectious Synovitis/Arthritis.  The CI had a pre-service injury to his right knee which was treated surgically in 1993.  He recovered and was cleared to enter active duty per the accession history and physical.  He reinjured his right knee while running on 15 May 2002 and developed an effusion (fluid) in the knee joint.  This became infected and was treated with multiple courses of oral and IV antibiotics as well as irrigation and drainage with washout on multiple occasions over the next 10 months.  In orthopedics on 11 June 2003, he reported mild pain.  Swelling and stiffness were significantly improved.  On examination, he had tenderness along the joint line, but full range of motion (ROM) at 0-140 degrees and a stable knee without an effusion.  There was atrophy of the quadriceps muscle.  He was thought to have post-infectious arthritis and synovitis (inflammation of the connective tissue lining of the joint).  Rehabilitation was continued and the CI was referred for MEB at his request.  The narrative summary (NARSUM) was dated 19 September 2003, 3 months prior to separation, and dictated by the treating orthopedic surgeon.  The CI reported considerable pain with activity and standing despite rehabilitation.  On examination, his knee had no effusion and the ROM (-5 to 150 degrees) exceeded VA normal values.  Diffuse joint line tenderness was present, but the knee was stable.  Significant quadriceps atrophy remained.  X-rays showed mild joint space narrowing on weight bearing views.  No comment was made on the gait.  A VA Compensation and Pension (C&P) examination was not performed.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee at 20%, coded 5008-5002 (streptococcal arthritis-rheumatoid arthritis).  The VA rated the knee at 10%, coded 5257-5003 (other impairment of the knee-degenerative arthritis).  The knee was stable, the ROM normal, and effusion resolved.  The Board found no route to a rating higher than the 20% 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 right knee condition.  

Contended PEB Conditions.  Alcohol dependence is not a condition that is compensable or ratable.  Therefore there is insufficient cause to recommend a change in the PEB determination for the history of alcohol dependence and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the post infectious synovitis/arthritis condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended “history of alcohol dependence”, the Board unanimously recommends no change from the PEB determination.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  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 201141230, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00017.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings