RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2016-00246
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080929

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Radio Operator-Maintainer, medically separated for “chronic left knee pain…” and “left saphenous nerve injury/neuroma…,” rated 10% each, with a  combined disability rating of 20%.  

CI CONTENTION:  The CI asserts that the progressive nature of his conditions was not properly assessed during the medical boarding process.  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 - 20080730	VARD - 20160513	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5259	10%	Left Knee Osteoarthritis 	5010-5260	10%	20160511	
Left Saphenous Nerve Injury/Neuroma…	8527	10%	Left Lower Extremity Peripheral Neuropathy	8527	0%	20160511	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left knee during physical training in January 2008.  Magnetic resonance imaging demonstrated an “extensive” meniscal tear (both medial horns), although all four ligaments were intact.  He underwent surgery (arthroscopic meniscectomy) soon afterwards on 8 February (8 months before separation).  There was ample documentation in post-operative STR clinical entries of grossly normal range of motion (ROM), although one noted a non-specific decrease in flexion; and, and there were no entries that indicated significantly limited ROM.  There were entries that indicated an intermittent gait disturbance, but ample STR documentation of the absence of persistent effusion, locking, or instability. 

A 1 April 2008 orthopedic addendum, 6 weeks before the NARSUM, documented baseline pain rated 1/10 escalating to 5/10 “with activity” that included walking, and that prohibited running and most general soldiering requirements.  The physical examination recorded “minimal” tenderness (no comment regarding effusion), 4-plane stability to stress testing, and goniometric ROM measurements of flexion to 120 degrees (normal 140) and 0 degrees extension (normal 0)

The 19 May 2008 NARSUM examination, 4 months prior to separation, documented unquantified pain, with “occasional” subjective locking and giving way, that was aggravated by prolonged walking, standing, and stairs; and, that prohibited “impact activities.”  The physical examination recorded “a slight limp,” tenderness, the absence of effusion, stability to stress testing, and negative signs of impingement (no objective locking).  Although no interim injury or other explanation was documented, the measured ROM recorded in the NARSUM was significantly worse than that detailed in the preceding orthopedic addendum, or that reflected by any other STR entries.  The NARSUM measurements appear to have been taken from a later (11 July) physical therapy evaluation, and were flexion to 71 degrees with minus 7 degrees extension, specifying motion limited by pain.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic).  The VA also rated the left knee pain condition 10%, coded 5010-5260, (traumatic arthritis and, limitation of flexion of leg), based on the C&P examination over 8 years after separation citing painful motion.  

There was no evidence for persistent effusion, locking, or instability to support a rating higher than 10% under any applicable code.  The panel considered analogous rating under code 5299-5262 (tibia and fibula, impairment of) which offers ratings for contiguous knee disability; but, members agreed that the analogous application of this fracture code was not sufficiently justified in a case such as this which satisfies compensable criteria under more applicable codes. 

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 of the left knee pain condition.

Left Saphenous Nerve Injury/Neuroma.  The orthopedic addendum, corroborated by STR entries, documented the development of a neuroma (benign nerve tumor) in the surgical incision, specifically negating surgical trauma to the nerve.  This resulted in complete numbness over the distribution of the saphenous nerve (medial calf and ankle).  All examiners recorded the absence of any muscle weakness (consistent with the fact that the saphenous nerve has no motor function).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s rated the left saphenous nerve injury/neuroma condition 10% coded 8527 (saphenous nerve code) citing complete paralysis.  The VA rated the left saphenous nerve injury/neuroma condition 0%, coded 8527 (saphenous nerve code), based on the C&P examination over 8 years after separation.  There was no justification for an alternative code and no VASRD §4.124a route to a rating higher than the PEB’s 10%.

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 of the left saphenous nerve condition.

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the left saphenous nerve condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160401, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170015173, XXXXXXXXXXXXXXXXXX

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