RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00637
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Health Care Specialist, medically separated for “right knee comminuted patellar fracture” with a disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the Panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service connected conditions after separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel 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 - 20050920	VARD - 20070417	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Comminuted Patellar Fracture	5099-5003	20%	Fracture Patella, Right Knee	5257	0%	STR	
Fracture Left Carpal Scaphoid Post-Bone Graft	Not Unfitting	Fracture, Carpal Scaphoid, Left Wrist	5211	NSC		
Post-Traumatic Stress Disorder (PTSD)		PTSD	9411	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Comminuted Patellar Fracture.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began on 25 February 2004 after the right patella (knee cap) fractured during impact in a tank accident.  Surgery was performed.  The post-operative period was complicated by prolonged use of prescribed pain medications.  Post-surgical X-rays performed in 2004 showed multiple patellar fragments over the right knee joint and disuse osteopenia (loss of bone density).  

During the 21 April 2005 MEB NARSUM examination, 5 months before separation, the CI reported constant pain and pain with weight bearing and walking.  The physical examination showed use of a long leg hinged knee brace and produced pain with flexion and extension.  There was no evidence of instability.  Range of motion (ROM) testing showed a flexion of 0-95 degrees (normal 0-140) with evidence of painful motion.  

There was no VA Compensation and Pension evaluation performed.  However, at a 3 May 2006 orthopedic appointment, 7 months after separation, the physical examination showed joint line tenderness and pain with patellar compression (objective evidence of patellar cartilage damage).  X-ray studies showed an abnormal patella suggestive of patellofemoral chondromalacia (abnormal cartilage causing chronic pain).  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 20% for the right knee condition, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy for moderate pain.  The VA rated 0% for the right knee condition, coded 5257 (knee, other impairment of), based on the STR documentation of fracture and surgical intervention, however, cited the absence of current objective medical evidence.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.   There was no documentation of ankylosis for a higher rating under 5256.  There was no clinical evidence of severe recurrent subluxation or lateral instability (5257) for a higher rating.  There was no documentation of flexion limited to 15 degrees (5260) and no evidence of extension limited to 20 degrees (5261) that would result in a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

Contended PEB Conditions:  Fracture Left Carpal Scaphoid (Wrist) Post-Bone Graft and PTSD.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

PANEL FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left wrist fracture and PTSD conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150603, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004780, 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