RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00627
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Army National Guard E4, Cavalry Scout, medically separated for “chronic left knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI requests the Board consider all conditions.  The 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 – 20090807	No VA Claim in Evidence	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%		
Gastroesophageal Reflux Disease (GERD)	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in February 2009 after falling off of an armored vehicle.  Diagnostic imaging (X-ray) studies showed no evidence of fracture or dislocation, or injury to cartilage or ligaments.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left knee pain,” for PEB adjudication.

At a physical therapy (PT) evaluation on 25 March 2009, 6 months prior to separation, the CI reported 5/10 pain with deep squatting or prolonged sitting.  
Physical examination showed minimal left knee joint swelling and range of motion (ROM) that was “full”, but unmeasured.  Left knee tenderness and painful motion were present.  Ligament testing was normal.  One test for possible meniscal injury (McMurray) was positive on the left.  A follow-up outpatient clinic examination on 3 April 2009 noted the CI to use a cane for ambulation and to wear a knee brace.  ROM was “decreased” but not measured, and knee tenderness was present.

At an orthopedic evaluation on 7 May 2009, 4 months prior to separation, the CI complained of pain while ascending or descending stairs.  Physical examination showed left knee flexion of 140 degrees (normal 140) and extension of 0 degrees (normal 0).  Patellar tracking was normal, the McMurray test was negative for possible meniscal injury and ligaments were stable.

During the MEB examination dated 25 June 2009, 2 months prior to separation, the CI reported ongoing left knee pain for which he wore a brace all day.  The pain was aggravated by negotiating stairs and prolonged sitting, especially in a vehicle.  He could not run, jump or perform other impact activities.   Physical examination showed a slightly abnormal gait due to the use of a cane.  Mild left knee tenderness was present.  There was no swelling, warmth, redness or ligament instability.  The McMurray test was negative.  He had normal strength and muscle atrophy was not present.  Left knee flexion was 125 degrees and extension was 0 degrees.  There was no change in ROM after repetitive motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10% coded 5099-5003 (arthritis, degenerative).  There was no VA examination or rating in evidence.  The Board agreed there was evidence of painful motion with functional loss supporting the 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (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).  Board members therefore concluded there was no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB.  After due deliberation, and 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 chronic left knee pain condition.

Contended PEB Condition: GERD.  The Board’s main charge is to assess the fairness of the PEB’s determination that GERD was not unfitting.  The GERD condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance-based evidence from the record that the GERD 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 GERD condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended GERD 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, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005105, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					       
						      					
Enclosure