RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01615
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090511

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Chemical, Biological, Radiological and Nuclear Operations Specialist, medically separated for “[left knee] retropatellar pain syndrome [RPPS]” with a disability rating of 10%.

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 - 20090202	VARD - 20090713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee RPPS	5099-5003	10%	Left Knee RPPS	5299-5261	10%	20090615	
Adjustment Disorder	Not Unfitting	Depressive Disorder, NOS	9434	30%	20090618	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Left Knee RPPS.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s condition began in May 2005 after an ammunition box was dropped on his left knee.  Radiographic studies were normal and showed no arthritis or structural abnormalities.  There was no surgical indication.  The 7 November 2008 MEB physical therapy evaluation recorded range of motion (ROM) of 0-140 degrees (normal 0-140).  Painful motion was not addressed and there was no loss of ROM after repetition.   The 8 December 2008 MEB NARSUM, 5 months prior to separation, noted complaints of left knee pain which rendered the CI unable to:  march, run, carry heavy loads, jump or quickly dress and undress himself.  Physical examination showed mild kneecap tenderness.  There was no ligamentous laxity, effusion or crepitus (grinding or crackling joint noise), and sensory and motor strength were intact.  The ROM was “normal” but painful motion was not addressed.

At the 15 June 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported left knee pain, instability, giving way and weakness with locking 1-3 times per month, which caused difficulty walking.  Physical examination showed ROM of 0-100 degrees with painful motion noted.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion.  The VA also rated the left knee condition 10%, analogously coded 5299-5261 (leg, limitation of extension), based on the C&P examination, citing painful motion.

The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no STR history 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 the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, there was painful motion with functional loss to support the PEB’s 10% rating IAW §4.59, §4.40 and §4.45.  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 left knee condition.

Contended PEB Condition:  Adjustment Disorder.  Adjustment disorder is not a condition that constitutes a disability.  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 left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder, 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.  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 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007964, 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