RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00538
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060720

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “right lateral tibial plateau fracture” with a disability rating of 0%.  

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 Medical Evaluation Board (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 - 20060707	VARD - 20070305	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Lateral Tibial Plateau Fracture	5099-5003	0%	S/P Surgical Repair of Tibial Plateau Fracture	5299-5261	10%	20061010	
Left Great Toe Nonspecific Trauma	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Lateral Tibial Plateau Fracture.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right tibia condition began in January 2006 during basic training when she jumped off the back of a truck in full battle equipment and fractured the right tibial plateau (top of long bone right below the knee).  She underwent repair surgery in February 2006.  X-rays in March 2006 revealed three screws present in the tibial plateau.  Bony structures about the right knee were otherwise intact.
During a physical therapy examination on 27 April 2006, 3 months prior to separation, the CI reported tolerable right knee pain. Physical examination revealed right knee effusion, retropatellar pain, muscle weakness, and right lateral tibial plateau tenderness.  Right knee flexion was 130 degrees (normal 140) with extension of 0 degrees (normal) and no pain.  

The 17 May 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of right knee pain, snapping and popping.  Physical examination showed right knee tenderness, and no palpable snapping or popping.  The right lower-distal extremity was neurovascularly intact.  Right knee flexion was 125 degrees and extension was normal.  Painful motion was not addressed.

At the 10 October 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported chronic right knee aching and sharp pain elicited by physical activity.  The right knee was weak and lacked endurance. The CI denied incapacitation. Physical examination showed a normal gait without use of an assistive device for ambulation.  Right knee tenderness present, flexion and extension were normal but with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5003 (degenerative arthritis), citing without significant loss of joint motion.  The VA rated the right knee condition 10%, analogously coded 5299-5261 (leg, limitation of extension) based on the C&P examination, citing residual knee surgery tenderness.  

The panel agreed there was no limitation of flexion or extension (5260 or 5261), no meniscal surgery (5259), no evidence of dislocated meniscus or loss body causing frequent locking with recurrent effusions (5258), or fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support a rating under those codes.  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45).  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 right knee condition, coded 5099-5003.

Contended PEB Condition:  Left Great Toe Nonspecific Trauma.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled and did not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended left great toe condition, the panel recommends no change from the PEB determination as not unfitting.  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	
Right Lateral Tibial Plateau Fracture	5099-5003	10%	

AR20190002403, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

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.