RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00947
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20060521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Tactical Unmanned Aerial Vehicle Operator, medically separated for “right knee instability” and “right ear hearing loss,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  “I believe my rating should be changed because my right knee instability is so bad that it gives out on me on a regular basis.”  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 - 20060322	VARD - 20060512	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posterolateral Corner Instability Rt Knee, with Laxity in Varus and Valgus…	5257	10%	Rt Knee Instability With Lateral Collateral Ligament Tears	5257	20%	20060130	
High Frequency Hearing Loss Rt Ear…	6100	0%	Bilateral High Frequency Hearing Loss	6100	0%	20060130	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Knee.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition was initially attributed to doing “mule kicks” in basic training in 2004 and later attributed to stepping in a hole and sustaining a hyperextension injury.  An initial MRI in October 2004 showed a medial meniscus tear; after physical therapy and activity- limiting profiles the knee pain was largely resolved and instability, particular with lateral movements, became the main complaint.  A repeat MRI in September 2005 showed no abnormality of the menisci and suggested a lateral collateral ligament tear.  After discussion with his orthopedic surgeon concerning the risks, benefits and options the CI decided not to undergo an attempt at surgical correction.  

The 25 January 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of instability with ambulation, especially with side-to-side movements.  The CI did note some occasional swelling but denied locking.  He was unable to walk on uneven terrain, do repetitive bends and squats and was not able to run or ruck march.  Physical examination showed a normal gait, full range of motion (ROM) with no mention of painful motion.  There was laxity of the right knee when compared to the left in varus and valgus (side-to-side) movements.  There was no evidence of front-to-back instability.  

At the 30 January 2006 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported right knee pain and instability that was made worse by walking, bending, prolonged standing, and cold weather.  Physical examination demonstrated a normal gait.  ROM was 130 degrees of flexion (normal 140) and extension to 0 degrees (normal).  Varus stress on the right knee showed 15 degrees of deviation compared with 0 degrees on the left.  There was no pain, weakness, fatigue or incoordination following repetitive motion.  There was no swelling, joint effusion or tenderness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee instability condition 10%, coded 5257 (knee, other impairment of), citing laxity in the varus and valgus with dial test showing 15 degrees asymmetry compared to the left.  The VA rated the right knee instability condition 20%, coded 5257, based on the C&P examination, citing recurrent subluxation or lateral instability of the knee, which was moderate.  

There was evidence of lateral instability with lateral movements and ambulation on uneven ground to support a 10% rating under the 5257 code as adjudicated by the PEB.  There was no limitation of motion (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 these respective codes.  There was likewise no fracture, nonunion or malunion of the femur or tibia to support consideration under the 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

Right Ear High Frequency Hearing Loss.  According to the STR and MEB NARSUM, the CI’s right ear hearing loss condition began prior to entering the Army.  The CI required an aeromedical waiver to be allowed to fly unmanned aerial vehicles due to his H3 profile at enlistment.  The 25 January 2006 MEB NARSUM examination, 4 months prior to separation, did not address the CI’s long-standing hearing loss.  At the same-day audiology evaluation, the CI gave a history of bilateral hearing loss that was present when he entered the Army in 2003.  He also noted ringing in the ears.  An audiogram showed the average of 1k, 2k, 3k and 4k Hz in the right ear of 35 dB and 33.75 in the left.  Word recognition using the Maryland CNC (a standardized test for speech discrimination) was 96 percent in the right ear and 92 percent in the left.  

At the 30 January 2006 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported difficulty hearing talking in a room full of people.  The audiogram revealed right ear values of 30 dB at 3k and 60 dB at 4k on the left and 60 dB at 3k and 65 at 4k.  Word recognition using the Maryland CNC was 92 percent on the left and 96 percent on the right.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right ear hearing loss condition 0%, coded 6100 (hearing impairment), citing average 35 dB loss and a speech discrimination score of 100 percent in the right ear.  The VA also rated the right ear hearing loss condition 0%, coded 6100, (hearing impairment), based on the C&P examination 4 months before separation.  

The panel noted that the average of the 1k, 2k, 3k and 4k Hz thresholds was 35 dB for the right ear and 33.75 dB on the left.  When those values were used in the VASRD §4.85 tables VI and VII they validate a 0% rating coded 6100 as adjudicated by the PEB.  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 hearing loss.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right ear hearing loss condition and IAW VASRD §4.85, the panel 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 20170214, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005499, 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