RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01391
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Combat Engineer, medically separated for “chronic pain left leg…,” with a disability rating of 20%.  

CI CONTENTION:  The CI requested a review of 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 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 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 - 20061017	VARD - 20070412	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Leg..	5099-5003	20%	Residuals, Closed Fracture, Tibia, with Internal Derangement, Left Knee	5262	30%	20061208	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in November 2005 to have a displaced tibial plateau fracture surgically corrected, after he was injured by a slide tackle while playing soccer.  Following surgery, a complication significantly reduced the range of motion (ROM) of his left knee, and he had a second procedure in April 2006 to correct that problem.  Further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “closed fracture of the tibia (status post-surgical repair)” for PEB adjudication.  

Radiographic imaging on 31 August 2006 showed no significant interval change in the position of the fracture fragments, and the orthopedic hardware was without loosening or metal fracture.  At the physical therapy (PT) examination 24 August 2006, 3 months prior to separation the CI reported his left knee and calf pain ranged from 2-8/10 on a daily basis and was worse at night.  He reported that wearing a hinge knee brace helped decrease the pain.  The physical examination noted his left knee with minimal edema, tenderness over the medial and lateral joint line and medial distal hamstring insertion.  The CI had an antalgic gait.  Active ROM was 0-135 degrees (normal 140).  At a PT examination 26 September 2006, 2 months prior to separation, the CI reported ongoing left knee pain.  The physical examination noted an antalgic gait while wearing a knee brace.  His left knee active ROM was 0-135 degrees (normal 140) with 4/10 pain.  At the MEB NARSUM examination 5 October 2006, a month prior to separation CI reported an average constant daily pain level of 4/10 that increased if he moved the wrong way, or walked too much.  The MEB physical examination noted the CI wore a knee brace and had some tenderness.  Left knee strength was 4/5 limited by pain.  His left knee active ROM was 0-135 degrees (normal 140) with 4/10 pain.  Extension was to 0 degrees (normal 0) also with 4/10 pain.  

At the 8 December 2006 VA Compensation and Pension (C&P) evaluation, performed a month after separation, the CI reported he was unable to stand more than a few minutes, or walk more than a few yards.  Physical examination noted pain, instability, giving way and weakness.  The CI wore a knee brace, used a cane and had an antalgic gait.  His flexion was 0-100 degrees (normal 140) with repetitive use.  His extension was 0-90 degrees with repetitive use.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 20%, coded analogously to 5003 (arthritis, degenerative), citing marked/constant pain in accordance with the US Army Physical Disability Agency pain policy.  The VA rated the left knee condition 30%, coded 5262 (Tibia and fibula, impairment of), citing a malunion of the tibia and fibula with marked knee or ankle disability.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 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 rating under the respective codes.  There was no 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).  However, there was evidence of painful motion with functional loss (based on §4.59, §4.40 and §4.45).  The ROM values and examination findings reported by the VA examiner (a month after separation) are significantly worse than those reported by the MEB examiner (a month prior to separation), and the PT evaluation (3 months prior to separation).  There was no record of recurrent injury or other development in explanation of the more marked impairment reflected by the VA examination.  While conditions may become progressively worse over time, there was no evidence in the record from which to conclude that the severity at separation approached that portrayed by the VA examination.  Members agreed that the MEB and PT examinations were more consistent with the STR and more reflective of the anticipated severity based on the clinical pathology.  The Board therefore relied more heavily on those examinations.  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.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends no change in the PEB adjudication.  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 20150615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006591, 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