RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01501
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040706

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Infantryman, medically separated for “chronic pain due to retropatellar pain syndrome, right knee” and “irritable bowel syndrome,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  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 (VA), 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 – 20040430	VARD - 20041105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Retropatellar Pain Syndrome	5099-5003	10%	Right Knee Meniscus Tear, Partial ACL Tear	5260	10%	20040624	
Irritable Bowel Syndrome 	7319	10%	Irritable Bowel Syndrome	7346-7319	10%	20040624	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Retropatellar Pain Syndrome, Right Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI initially injured his right knee in 1998 while deployed.  His knee went out while he was maneuvering down a mountain side.  The CI recovered from this incident but then in October 2002 he reinjured the knee while wrestling.  An MRI on 12 December 2002 revealed a partial ACL tear and a tear of the anterior horn of the lateral meniscus as well as mid-substance degenerative tear of the posterior horn of the medial meniscus.  He was referred to orthopedics where the physical examination did not confirm those findings.  The orthopedic surgeon felt there was no surgical indication and the CI was treated conservatively.  

At the 6 October 2003 orthopedic appointment the CI reported pain behind the kneecap with occasional mild swelling.  The CI denied locking.  Range of motion (ROM) was flexion of 140 degrees (normal) and extension was 5 degrees of hyperextension (0 normal).  During the 21 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported right knee pain and that he wore a knee stabilizer when participating in sports.  Physical examination showed no knee tenderness to palpation.  The 21 January 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of inability to perform multiple activities required of his MOS to include running, jumping, carrying a rucksack or equipment and unable to sit in the turret of a Bradley vehicle.  Physical examination referred to the DD Form 2808 of the same date.  

At the 24 June 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported right knee pain that was somewhat improved with oral anti-inflammatory medication.  Physical examination showed no evidence of swelling or inflammation.  The full ROM was not recorded, but the examiner did note pain at 90 degrees of flexion (140 normal) and extension was to 0 degrees (normal).  There was no additional limitation by pain, fatigue, weakness or lack of endurance following repetitive movement.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (analogous to arthritis degenerative), citing application of the US Army Physical Disability Agency pain policy.  The VA also rated the right knee condition 10%, coded 5260, (leg, limitation of flexion of), based on the C&P examination 1 month before separation.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no history or evidence 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 those codes.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 right knee condition.  

Irritable Bowel Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s onset of intermittent loose stools started in April 2003 with intermittent fecal urgency passing 5-7 stools per day without hematochezia (bright red blood in the stool).  He sought treatment in September 2003.  

The 16 March 2004 MEB NARSUM examination noted complaints of intermittent loose stools, sometimes up to 5-7 episodes per day.  He denied blood with the loose stools.  There was no history of unintentional weight loss.  Physical examination showed a normal abdominal evaluation.  At the 24 June 2004 C&P evaluation the CI reported intermittent abdominal pain with cramping, constipation and 6-8 loose stools per day.  The CI reported that he had been taking a medication to decrease colon spasms as well as a fiber supplement and that these treatments provided good relief of symptoms and no history of side effects.  Physical examination showed a normal evaluation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the irritable bowel syndrome condition 10%, coded 7319 (irritable colon syndrome), citing moderate.  The VA also rated the irritable bowel syndrome 10%, dual coded 7346-7319, (hernia, hiatal-irritable colon syndrome), based on the C&P examination 1 month before separation, citing good relief of symptoms with medication.  

Panel members agreed that the degree of disability from the irritable bowel syndrome did not rise to the level of severe, with diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress to justify the next higher 30% rating.  There are no other 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 for the irritable bowel syndrome condition.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the irritable bowel syndrome 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.  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 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180001623, 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