RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX			                         CASE:  PD-2017-01948
BRANCH OF SERVICE:  army	SEPARATION DATE:  20061214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic left knee pain” 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 - 20060929	VARD - 20070409	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Left Knee Patellofemoral Dysfunction	5260	10%	20070313	
GERD	Not Unfitting	GERD	7399-7346	10%	20070313	
Hearing Loss	Not Unfitting	Bilateral Hearing Loss	6100	0%	20070313	
Pes Planus	Not Unfitting	Pes Planus	5276	10%	20070313	
Hyperlipidemia	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Right Knee Pain.  According to the MEB narrative summary (NARSUM) and service treatment record (STR), the CI’s left knee condition began in 2005 without injury or trauma.  Left knee X-rays showed no significant abnormality and surgery was not a treatment option.  A physical therapy range of motion (ROM) study on 28 March 2006, 10 months before separation, showed left knee flexion of 135 degrees (normal 140) and extension of 0 degrees (normal).  Painful motion was present.  

The 10 August 2006 MEB NARSUM examination, 4 months before separation, noted complaints of left knee pain under the kneecap.  The ROM evaluation showed left knee flexion of 115 degrees and extension of 0 degrees.  Painful motion was present.  

During the 20 March 2007 VA Compensation and Pension (C&P) examination, 3 month after separation, the CI reported left knee pain elicited with physical activity.  The ROM study showed left knee flexion of 90 degrees and extension of 0 degrees.  Painful motion was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing no significant loss of joint motion or instability.  The VA rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing painful motion.  The panel agreed there was no limitation of motion under codes 5260 and 5261 to support a 10% rating; however, there was sufficient evidence of painful motion IAW VASRD §4.59 to support a 10% rating.  There was no history of 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 higher rating under those codes.  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 left knee condition, coded 5299-5260.  

Contended PEB Conditions: Hearing Loss, Hyperlipidemia, GERD (Gastroesophageal Reflux Disease) and Pes Planus.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions failed retention standards and only the hearing loss was profiled (H2).  Although GERD was implicated in the commander’s statement, there was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5299-5260 IAW VASRD §4.71a.  In the matter of the contended GERD, hearing loss, hyperlipidemia and pes planus, 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.

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Knee Pain	5299-5260	10%	

AR20180015097, 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.