RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00908
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20071220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “osteochondritis dissecans, right knee” and “tenosynovitis right rotator cuff,” rated 0% each, with a combined disability rating of 0%.  

CI CONTENTION:  “I had to have a high tibial osteotomy and now a total knee replacement form that injury.”  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 – 20071114	VARD - 20090714	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteochondritis Dissecans, Right Knee	5099-5003	0%	Osteochondritis Dissecans, Right Knee	5260	10%	20090403	
Tenosynovitis Right Rotator Cuff	5024	0%	Rotator Cuff Tendonitis and Subacromial Bursitis, Right Shoulder	5299-5203	10%	20090403	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Osteochondritis Dissecans (OCD), Right Knee:  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured his right knee in 2001 playing high school football.  His medical history (as obtained from the NARSUM) denoted that the CI had multiple surgeries performed on his right knee between 2001 and 2005.  In April 2006 he was granted a medical waiver and enlisted in the Regular Army.  He deployed from November 2006 thru March 2007 where he endorsed worsening right knee pain during the deployment.  An MRI performed in March 2007 noted evidence of OCD and a small effusion.  On 23 April 2007, the CI underwent another right knee surgery that included a femoral chondroplasty (to deal with the OCD) and a shave debridement of the lateral meniscus.  His painful right knee condition did not improve with surgery and he was given a permanent L3 profile and went before the Medical MOS Retention Board (MMRB) which recommended that he enter the disability evaluation system.  

At the 2 November 2007 MEB NARSUM examination, approximately 2 months prior to separation, the CI’s chief complaint was “right knee pain” which was “usually tolerable unless exacerbated by activity.”  He rated his pain as slight and constant.  His physical examination (PE) revealed non-painful right knee range of motion (ROM) measured at 125 degrees of flexion (normal 140) and normal extension.  The examiner indicated that the ROM was “slightly below norms but appears normal for patient (muscle mass prevents further flexion).”  Kneecap tenderness was present and there was no evidence of instability.  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 right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing no limitation of motion.  The VA rated the right knee condition at 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination 16 months after separation, citing pain causing functional loss.  There was no limitation of motion that supported a rating under the diagnostic code for limitation of flexion or extension (5260, 5261).  However, the persistence of pain after meniscal surgery warranted a 10% rating under 5259 code (cartilage, semilunar, removal of symptomatic).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  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).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition.

Tenosynovitis Right Rotator Cuff:  According to the STR and the MEB NARSUM, the right-hand dominant CI injured his right shoulder in 2007 when he fell on his crutches while recovering from right knee surgery In October 2007, a subsequent MRI of the right shoulder revealed mild rotator cuff tendonitis without tear.  The CI was diagnosed with right shoulder bursitis.  According to the 2 November 2007 MEB NARSUM evaluation, the examiner noted tenderness, without instability or weakness about the right shoulder.  His right shoulder ROM was painful with decreased flexion to 150 degrees (normal 180), abduction was normal.  There was no evidence of tendon tear or retraction.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5024 code (tenosynovitis), citing above stated ROM measurements; whereas, the VA assigned a 10% rating using an analogous 5299-5203 code (clavical or scapula impairment), based on the C&P examination 16 months after separation, citing pain causing functional impairment.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right shoulder condition.
BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  In the matter of the right shoulder (rotator cuff) condition, the panel unanimously recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain (OCD)	5259	10%	
Tenosynovitis, Right shoulder	5024	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170208, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004956, 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. 

Sincerely,					      
Enclosure