RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01967
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Signal Support Systems Specialist, medically separated for “chronic left knee pain” with a disability rating of 10%.  

CI CONTENTION:  “They didn’t take into account my TBI, PTSD/anxiety disorder, or any of the issues pertaining to my back.”  The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090312	VARD - 20091210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Residual Pain, Loss Of Function Left Knee 	5299-5259	10%	20090730	
			Benign Surgical Scar, Left Knee	7804	0%		
Adjustment Disorder	Not Compensable	Major Depressive Disorder	9434-9400	30%	20090811	
Mild Traumatic Brain Injury (TBI)	Not Unfitting	Mild TBI 	8045	10%	20090813	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee arthroscopy with synovectomy in June 2008.  During the 17 December 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported swelling and pain in the left knee that caused him to limp and “gave out.”  He also wore a knee brace.  Physical examination revealed a slightly antalgic gait, with an “ok” heel and toe walk and left knee pain while on heels.  Strength was limited by pain to 4/5.  There was no effusion.  Range of motion (ROM) was flexion of 95 degrees (normal 140) and extension of 0 degrees (normal).  

The 3 February 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of 5/10 pain flaring to 8-9/10.  He was unable to run or jump without significant pain.  Other aggravating factors were squatting, walking stairs, prolonged standing, and rucking with his gear.  Physical examination referenced the MEB examination by the same physician and provided the same conditions and ROM as above.  

At the 30 July 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant, moderate soreness in the knee with severe exacerbations twice weekly that lasted all day.  When severe, the CI could hardly bear his own weight.  He always wore a brace and was only able to stand for 15-30 minutes, but could walk one-fourth to one whole mile.  Physical examination showed a limping gait favoring the left knee.  There was moderate tenderness and mild swelling around the posterior patella.  The ROM evaluation showed flexion of 90 degrees with pain at endpoint and normal extension.  There was no change in ROM or pain level after three repetitions.  

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 limitation of motion.  The VA rated the left knee condition 10%, analogously coded 5299-5259 (cartilage, semilunar, removal symptomatic), based on the C&P examination, citing symptomatic removal of the semilunar cartilage.  

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 with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no history or evidence 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 those codes.  There was therefore no higher rating than the 10% adjudicated by the PEB under any applicable VASRD code.  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 Condition:  Adjustment Disorder.  The panel noted that IAW DoDI 1332.38, in effect at the time of separation, this condition did not constitute a physical disability.  The diagnoses of PTSD and severe anxiety disorder noted on the CI’s DD Form 294, were not identified by the MEB or PEB, and are not within the scope of the PDBR review.  Adjustment disorder cannot be found to be compensable and no additional disability rating is recommended.  

Contended PEB Condition:  Mild TBI.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 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 agrees it cannot recommend it for additional disability rating.  In the matter of the contended mild TBI condition, 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010154, 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