[AR Number], XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      

Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2016-01632
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041029

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Motor Transport Operator, medically separated for “chronic left thigh and knee pain” with a disability rating of 10%.

CI CONTENTION:  “They only considered the knee. They didn't consider the other injures that I received while I was in combat.  I sustained massive muscle and nerve damage to the same leg that they only gave me a 10% rating for.”  He also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20041018	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Thigh and Knee Pain…	8526	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Thigh and Knee Pain.  The PEB combined the left thigh and knee conditions under a single disability rating, coded 8526 (femoral nerve paralysis, mild) and rated 10%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the conditions is presented separately, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

Chronic Left Thigh Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left thigh pain began in August 2003 after a gunshot wound to the left thigh with shrapnel injury and resulted in thigh weakness, and medial thigh, leg, and foot numbness.  At the 19 February 2004 orthopedic evaluation, the CI reported left thigh pain and the provider noted healed anterior and posterior left thigh scars and atrophy of the vastus medialis muscle with decreased left quadriceps strength.  The diagnosis was left saphenous nerve injury.  Nerve conduction studies on 11 March 2004 revealed denervation of the right vastus medialis muscle.  

During the 1 July 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, there was decreased left thigh muscle mass, pain on palpation, and 4/5 strength.  The MEB NARSUM examination the same day showed significant left atrophy of the vastus medialis muscle; absent light touch sensation in the medial knee, leg, and foot; and decreased light touch sensation along the anterior left thigh.  The examiner diagnosed partial femoral and complete saphenous nerve palsy, and noted that the left thigh pain, weakness, and left lower extremity numbness significantly precluded the CI’s ability to perform his military duties.  There was no VA examination proximate to separation in evidence.  

The panel first considered if the left thigh condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The condition was profiled, implicated in the commander’s statement and failed retention standards.  Members agreed the evidence reasonably justified that the functional limitations of the condition contributed to the CI’s inability to perform his military duties, and accordingly a separate disability rating is recommended.  

The panel directed attention to its rating recommendation based on the above evidence.  Members noted diagnoses of partial femoral and complete saphenous nerve palsy (paralysis) and agreed that the evidence supports a 10% rating for complete saphenous nerve paralysis, coded 8527 (internal saphenous nerve paralysis).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left thigh condition, coded 8527.  

Left Knee Pain.  According to the STR and MEB NARSUM, the CI’s left knee condition also began in September 2003 after the left thigh gunshot wound.  A 21 October 2003 MRI demonstrated a complex tear of the posterior horn of the medical meniscus and a fluid mass at the posterior edge of the semitendinosus tendon.  The CI underwent left knee arthroscopy in June 2004 with plica debridement with a healed medial meniscus tear noted during the procedure.  The left knee pain did not improve postoperatively.  

The MEB NARSUM examination noted complaints of significant left knee pain.  Physical examination showed full left knee ROM and tenderness along the posterior medial aspect; painful motion was not addressed.  The 16 August 2004 physical therapy ROM study, 3 months prior to separation, demonstrated left knee flexion to 105 degrees (normal 140) and normal extension, with pain during passive flexion.  

The panel considered if the left knee pain condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The condition was profiled, implicated in the commander’s statement, and failed retention standards.  Member agreed the evidence reasonably justified that the functional limitations of the condition contributed to the CI’s inability to perform his military duties, and accordingly a separate disability rating is recommended. 

The panel directed attention to its rating recommendation based on the above evidence.  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 non-compensable limitation of motion, pain with knee flexion, and functional loss due to pain with use to support a 10% rating (based on §4.59, §4.40 and §4.45).  While the CI had a meniscal tear, there was no evidence of frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under those codes.  After due deliberation, considering all f the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, coded 5299-5260.  

BOARD FINDINGS:  In the matter of the left thigh pain, the panel recommends a separately unfit determination with a disability rating of 10%, coded 8527 IAW VASRD §4.124a.  In the matter of the left knee pain condition, the panel recommends a separately unfit determination with a disability rating of 10%, coded 5299-5260 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Thigh Pain	8527	10%	
Left Knee Pain	5299-5260	10%	
COMBINED	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20160923, w/atchs  
Exhibit B.  Service Treatment Record