RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00956
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Technical Intelligence Analyst, medically for “chronic right knee pain,” and “left shoulder pain…” rated 0% and 0%, respectively, with a combined disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  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 - 20041015	VARD - 20050503	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain.	5099-5003	0%	Right Patellofemoral Syndrome claimed as Right Knee Condition	5099-5014	10%	20050215	
Left Shoulder Pain…	5099-5003	0%	Chronic Rotator Cuff Tendonitis, Left Shoulder	5201-5024	10%	20050215	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began after running in February 1998.  He had 3 arthroscopic surgeries—January 2002, August 2002, and February 2004.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right knee pain” for PEB adjudication.  

At the MEB NARSUM examination on 04 September 2004 (4 months pre-separation), the CI reported pain despite physical therapy and was instructed to wear a knee brace daily.  Physical examination showed tenderness and crepitus (indicative of arthritis) over the prepatellar (kneecap) region with no evidence of swelling or instability.  The NARSUM referenced separate physical therapy ranges of motion (ROM) that were not in evidence, however, the PEB cited a ROM of 5-135 degrees (normal 0-140).  

At the 15 February 2005 VA Compensation and Pension (C&P) evaluation (1 month after separation), the CI reported occasional “locking,” and pain after prolonged sitting and with maneuvering stairs.  The physical examination showed a ROM of 0-140 degrees.  There was tenderness of the medial joint line and medial patella with no evidence of edema, instability, laxity, or meniscal injury.  Radiographs showed normal joint spacing with no calcifications or spurring (degeneration or arthritis).  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (degenerative arthritis), citing a ROM of 5-135 degrees with crepitus and tenderness without evidence of instability.  The VA rated the right knee condition 10% coded 5099-5014 (osteomalacia), citing painful motion with normal radiographic findings.  

The Board agreed there was sufficient STR evidence of painful motion (tenderness and crepitus) with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45); as reported on the MEB NARSUM and VA C&P examinations.  There was no limitation of motion which attained a higher 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), or history of surgery to remove a meniscus (5259) to support a higher rating under the respective codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition, analogously coded 5099-5014 (osteomalacia).  

Chronic Left (Non-Dominant) Shoulder Pain.  According to the STR and MEB NARSUM, the CI’s left shoulder condition began after lifting heavy weights in July 2002.  He was diagnosed with impingement syndrome and had arthroscopic surgery (labral repair and Mumford Procedure) in January 2003 to ameliorate the shoulder pain (at the acromioclavicular [AC] joint).  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left shoulder pain” for PEB adjudication.  

On the MEB DD Form 2808 dated 24 August 2004 (5 months prior to separation), the examiner documented tenderness at the AC joint and full range of motion (ROM).  The MEB NARSUM examination on 04 September 2004 (4 months prior to separation), the CI reported pain despite rehabilitation efforts.  Physical examination showed tenderness to palpation over the AC joint with no swelling.  

At the 15 February 2005 VA C&P evaluation (1 month after separation), the CI reported pain with overhead movements, while driving, or working on the computer.  The physical examination showed tenderness of the lateral shoulder, and full ROM (180 degrees each of flexion and abduction).  There was evidence of impingement (Hawkins test) and AC joint injury (scarf sign).  Radiographic evaluation was normal without evidence of bone spurs or arthritis.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing AC joint tenderness, no impingement, and 170 degrees of abduction.  The VA rated the left shoulder condition 10%, analogously coded 5201-5024 (arm, limitation of motion; tenosynovitis), citing painful motion without limitation of motion.  

The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a 20% rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  Although there was no limitation of motion to support a rating under 5201, Board members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left shoulder condition, analogously coded 5201-5024.  

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5014 IAW VASRD §4.71a.  In the matter of the left shoulder condition, the Board unanimously recommends a disability rating of 10%, coded 5201-5024 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain.	5099-5014	10%	
Chronic Rotator Cuff Tendonitis, Left Shoulder	5201-5024	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000906 (PD201500956)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA