RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01389
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard O3, Artillery Officer, medically separated for “chronic left knee pain,” with a disability rating of 10%.

CI CONTENTION:   “Left and right knees need replaced, back pain + hearing loss + diverticulitis.”  The 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 condition(s) at the time of separation.  The panel 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 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 - 20061116	VARD - 20050331	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5003	10%	Left Knee Meniscus Repair with Degenerative Arthritis	5260	10%	20050216	
Intermittent Thoracic Back Pain	Not Unfitting	Degenerative changes of T-Spine	5242	10%		
Hearing Loss		Bilateral Hearing Loss	6100	0%	20050222	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI complained of left knee pain and recurrent effusions in November 2003.  He underwent his second left knee surgery in June 2004 and imaging showed degenerative changes and cartilage thinning as well as pre and post debridement of a medial meniscus tear.  Post-surgery, conservative orthopedic and physical therapy treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left knee pain, with osteoarthritis of the medial compartment and chronic partial ACL [anterior cruciate ligament] tear” for PEB adjudication.  

The 31 March 2005 VA Compensation and Pension (C&P) evaluation, performed 22 months before separation, documented normal left knee exam with the exception of tenderness to palpation along the medial joint line.  Range of motion (ROM) noted flexion to 125 degrees (normal 140).

The orthopedic consult to the MEB was conducted in August 2006.  Physical examination revealed trace effusion of left knee, the knee was stable and ROM was 100 degrees of flexion (normal 140).  The MEB NARSUM examination on 13 September 2006, 4 months prior to separation, noted complaints of chronic left knee pain with arthritis.  The CI noted that after surgery he had a course of physical therapy; however, his left knee remained painful, and there was no significant improvement.  He had knee pain with weight bearing activities only.  He also had intermittent swelling related to activity, and catching, but no locking.  The CI wore a knee brace and did not use any cane or crutches.  His knee pain was aggravated by running, prolonged walking, lifting, prolonged standing and going up or down stairs.  Physical examination reported ROM of left knee to 122 degrees of flexion (normal 140).  His gait was normal and there was some atrophy noted of his left quadriceps, but weakness was not reported.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain 10%, coded 5003 (degenerative arthritis) citing “major joint with radiographic evidence of DJD and slight loss of motion.”  The VA rated the left knee condition at 10% coded 5260 (Leg, limitation of flexion of), based on painful motion with consideration given to functional loss due to pain.

There was no limitation of motion supporting a higher rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, 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.  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).  Therefore, there was no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 left knee pain.  

Contended PEB Conditions.  The panel’s main charge is to assess the fairness of the PEB’s determination that the intermittent thoracic back pain and hearing loss conditions were not unfitting.  The back pain condition was not profiled, and although the hearing loss condition was profiled, there were no duty restrictions related to hearing loss.  Neither conditions were 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.  

BOARD FINDINGS:  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended intermittent thoracic back pain, and hearing loss conditions, the panel 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 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007575, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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