RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01471
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Machinist, medically separated for “chronic pain, left knee” and “chronic indigestion, status post surgery for ruptured appendix,” each rated at 10%, with a combined disability rating of 20%. 

CI CONTENTION:  The CI made no specific contention.  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 - 20040816	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	10%	No VA Examination in Evidence	
Chronic Indigestion…	7325-7319	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in early 1994 while weight lifting and doing heavy squats.  The following day, his left knee buckled in a varus direction with weight bearing.  Left knee X-rays were normal as was an MRI, except for a small joint effusion.  The CI was diagnosed with a posterior cruciate tear, casted for 6 weeks (hip to ankle), and treated with 4 months of physical therapy.  

During the 9 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported his knee pain began in 1993 and that he wore a knee brace to keep pain and swelling down.  Physical examination of the left knee showed painful motion at the end of range of motion (ROM).

At the 7 May 2004 MEB NARSUM examination, 3 months prior to separation, the CI complained of chronic left knee pain.  The examiner noted he was able to meet his intermittent National Guard duties in spite of the knee pain, but that he was unable to manage the physical training and activities required for the pre-deployment training his unit was undergoing at the time.  Physical examination showed left knee ROM flexion at 87 degrees with pain (normal 140), and tenderness around the ligament.  There was a positive Lachman’s test with pain and laxity, as well as decreased left leg muscle tone and strength compared to the right.  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 condition 10%, analogously coded 5009-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  Upon deliberation, members agreed that criteria for a higher 20% rating under 5003 code was not justified without evidence of incapacitating episodes with physician-prescribed bedrest.  However, a 10% rating was justified IAW §4.59 (painful motion) and §4.40 (functional loss) as adjudicated by the PEB.  There was no evidence of subluxation or lateral instability to support a rating greater than 10% under the 5257 code (knee, other impairment of).  There was no limitation of motion supporting a higher rating (5260, 5261), no history of surgery to remove a meniscus (5259), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  Finally, 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).  No additional functional limitation was evidenced by the examinations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic left knee pain condition.  

Chronic Indigestion.  According to the STR and MEB NARSUM, the CI’s indigestion began in 1991 following surgery for a ruptured appendix.  Post-surgery, the CI developed abdominal pain at the incision site, frequent heartburn, and reflux symptoms.  During the 9 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported chronic indigestion and ulcers from his ruptured appendix.  The examiner noted a history of bowel gangrene secondary to the ruptured appendix; however, a history of ulcers was not documented.  Physical examination recorded a negative guaiac test (no blood in stool).  
  
The 7 May 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic abdominal pain around the surgical incision site and frequent heartburn and reflux symptoms. Physical examination showed a soft abdomen with mild right lower quadrant tenderness, and absence of guarding, rebound, mass or enlarged abdomen organs.  The examiner noted the CI’s condition was fairly well- controlled with medication and dietary restriction.  There were no reports of fevers, chills, or mucus in the stools; and no indication of blood in the stool or signs of anemia recorded in the STR prior to separation. 
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic indigestion condition 10%, coded 7325-7319 (irritable colon syndrome), for moderate symptoms.  The panel considered whether the CI’s condition met the 30% rating criteria under code 7319, which requires “diarrhea documented as severe or alternating diarrhea and constipation in a severe pattern, with constant or near constant abdominal distress.”  The NARSUM documented a single finding of tenderness and report of chronic pain in the area of the surgical incision.  Members noted the absence of recorded malnutrition, anemia, weight loss, or serious complications and agreed a 30% rating was thus not justified.  There was no documented radiographic evidence of gastritis or ulcers to consider codes 7307 (gastritis) or 7306 or 7305 (ulcer codes).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic indigestion condition.

BOARD FINDINGS:  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the chronic indigestion condition and IAW VASRD §4.114, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161010, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001810, 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