RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01084
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Air Traffic Control Operator, medically separated for “chronic left knee pain due to multiple re-injuries of the medial meniscus” and “chronic left ankle pain due to multiple falls,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI requests the Board consider 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 - 20080404	VARD	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	No VA examination in evidence	
Chronic Left Ankle Pain	5099-5003	10%		
Chronic and Recurrent Bronchitis	Not Unfitting		
COMBINED RATING:  20%	RATING:  N/A	

ANALYSIS SUMMARY:  

Left Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in April 2003 while running during advanced individual training (AIT).  A 15 January 2004 left knee diagnostic imaging (MRI) study showed degeneration in the posterior horn of the medial meniscus.  On 23 February 2004 the CI underwent left knee arthroscopy with lateral patellar retinaculum (anterolateral portion of knee fibrous capsule) release.  The CI had no postoperative complications and resumed physical therapy (PT) to regain left knee function.  A 21 April 2005 left knee MRI showed a tear of the anterior medial meniscus.  On 16 May 2005 the CI underwent left knee arthroscopy and partial medial meniscectomy.  From July 2006 through October 2007, the CI deployed to Iraq.  She reported multiple falls secondary to her left knee “locking and giving way.”  In May 2007, she reported her left knee totally gave way and she fell down 4 flights of stairs.  The CI was issued an ankle brace and completed her tour with continuing symptoms.  A 14 December 2007 left knee MRI revealed an unchanged debrided radial tear and overall stable appearance of the medial meniscus.  

On 28 January 2008, as part of the MEB evaluation, the patient underwent additional evaluation including normal electrodiagnostic studies in Physical Medicine and Rehabilitation for her diagnosis of enthesopathy (disorder of muscular or tendinous attachment to bone) in her left lower extremity.  Despite surgery and treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “chronic medial meniscus tear, left knee, status post two meniscal debridement’s,” “chronic patellofemoral dysfunction, left knee” and “enthesopathy of the left knee, Gordy’s Tubercle” for PEB adjudication.  

In the 22 January 2008 NARSUM, 6 months before separation, the CI reported left knee “constant, dull and radiating pain” on “4/10 to 10/10” pain scale.  Pain was exacerbated by “walking more than 400 meters, kneeling, running any distance, walking up or down a flight of stairs, lifting more than 15 lbs., carrying more than 15 lbs., sitting in place for more than 30 minutes or standing for more than 30 minutes.”  The CI additionally reported decreased coordination and increased pain, “locking, popping and giving way” of her left knee with repetitive motion.  The physical examination documented a normal gait (heel-toe and tandem walk).  The left knee examination revealed moderate anterior knee, patellar, medial compartment, and lateral proximal tibial (Gurdy's) tubercle tenderness.  There was minimal hypesthesia (diminished sensation) over the Gurdy's tubercle and lateral peroneal region with minimal discoloration, decreased temperature, and joint line effusion.  Left knee repetitive active ROM, measured with a goniometer, was flexion of 120/116/114 (140) and extension of 0/0/0 (0) degrees.  The patellar apprehension (apprehension or pain on quadriceps contraction with patella displaced) and pivot shift (assesses anterior cruciate ligament [ACL]) tests were positive.  The Lachman (assesses ACL) and anterior/posterior drawer (assesses ACL and posterior cruciate ligament [PCL]) tests were negative.  Strength, sensation, and deep tendon reflexes (DTRs) were normal and pathologic reflexes were absent.  There was no VA Compensation and Pension (C&P) examination in evidence.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (arthritis, degenerative) citing chronic left knee pain due to multiple re-injuries of the medial meniscus, multiple arthroscopic repairs and debridement’s, stable knee joint, ROM, and loss of ROM due to painful motion.  The ROM values in the proximate examinations did not support a minimum rating under the limitation of knee flexion (5260) and extension (5261) codes.  While the CI underwent a partial medial meniscectomy, there was no dislocated meniscus (5258) or symptomatic removed meniscus (5259) for consideration under the respective codes.  There was no knee ankylosis (5256), knee recurrent subluxation/lateral instability (5257), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under the respective codes.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  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.  

Left Ankle Pain.  According to STRs and the MEB NARSUM, the, the CI’s left ankle condition began in April 2006 during pre-deployment certification exercises at the National Training Center (NTC).  There was no surgical indication and despite treatment, the ankle condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “chronic left ankle instability” for PEB adjudication.  

In the NARSUM the CI reported chronic pain and instability that prevented her from performing physical activities that required impact such as the APFT or climbing stairs.  She reported a constant “dull achiness” and pain on a 10/10 scale with use.  The CI reported wearing an ankle brace for all activities to prevent inversion.  The physical examination documented a normal gait.  The left ankle examination revealed anterior and anterolateral joint line tenderness.  Left ankle repetitive active ROM, measured with a goniometer, was dorsiflexion of 20/18/18 (20) and plantar flexion of 50/48/46 (45) degrees.  The anterior drawer and talar tilt tests were positive.  Sensation and DTRs were normal and pathologic reflexes were absent.  Strength was normal except for 4/5 dorsiflexion and eversion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (arthritis, degenerative) citing chronic left ankle pain, ankle instability, ROM, and loss of ROM due to painful motion.  There was no compensable limitation of ankle motion (5271), ankle ankylosis (5270), subastragalar or tarsal joint ankylosis (5272), os calcis or astragalus malunion (5273) or excision of the astragalus (5274) for consideration under the respective codes.  The Board agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  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 ankle condition.  

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

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.  In the matter of the left ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bronchitis 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 20150610, 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

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001263 (PD201501084)

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.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA