RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01781
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “left knee pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contended for migraines, PTSD, left knee, and upper back/neck pain.  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 - 20090511	VARD - 20100527	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	Degenerative Arthritis Left Knee…	5003	10%	20091016	
Adjustment Disorder	Not Unfitting	Major Depressive Disorder	9434	70%	20100312	
Migraines	Not Unfitting	Migraines	8100	10%	20091016	
Chronic Low Back Pain	Not Unfitting	Degenerative Disk Disease	5237	10%	20091016	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI’s knee pain began in April 2005 after falling during basic training.  Despite two surgical interventions (meniscal and ACL repair), intensive physical therapy (PT), medications, and restrictions, her painful symptoms remained and she was referred to the MEB.  

The 18 February 2009 MEB NARSUM examination, 6 months prior to separation, noted complaints of chronic left knee pain aggravated by running, jumping, the wearing of body armor, kneeling or squatting, push-ups, sit-ups, maneuvering stairs, carrying greater than 30 pounds, and standing for greater than 15 minutes.  Her physical examination (PE) as documented on 1 December 2008, 8 months prior to separation, revealed painful and decreased range of motion (ROM) of the left knee.  Flexion measured 125 degrees (normal 140) and extension was measured at 8 degrees (normal 0).  Manual maneuvers testing for knee joint instability were negative.  

At the 16 October 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported left knee pain and weakness, stiffness, swelling, heat, and joint give way.  She denied local redness, lack of endurance, locking, fatigability, deformity, tenderness, drainage, effusion, subluxation, and or dislocations of the left knee.  Her PE noted normal but painful motion of the left knee, and tests for joint instability were normal.  

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 (degenerative arthritis), citing satisfactory evidence of pain with consideration given to VASRD §§4.10 and 4.40.  The VA also rated the left knee condition 10%, coded 5003, based on the C&P examination, citing painful or limited motion of a major joint.  

The panel first agreed that a greater degree of probative value should be placed the VA examination due to its closeness to the date of separation as compared to the NARSUM examination.  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 painful motion supporting a 10% rating (based on §4.59).  Additionally, the examination proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under their 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).  There was therefore no VASRD §4.71a higher rating option than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  After due deliberation, considering all 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 Conditions:  Adjustment Disorder, Migraines, and Chronic Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for any of the contended conditions, so no additional disability ratings are 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, migraines, and chronic low back pain, the panel recommends no change from the PEB determinations 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008643, 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