RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02295
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050304

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Fire Support Specialist, medically separated for “posttraumatic degenerative patellofemoral arthritis, right knee” and “chronic pain left (non-dominant) hand,” rated 10% and 0%, respectively, with a combined 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 - 20050119	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Patellofemoral Arthritis, Right Knee	5010	10%	No VA Examination in Evidence 	
Chronic Pain Left (Non-Dominant) Hand	5099 5003	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sustained a hyper-flexion and twisting injury in November 2003, and underwent a partial medial meniscectomy in February 2004.  The 12 December 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of right knee pain exacerbated by walking and running.  The physical examination (PE) revealed painful and decreased range of motion (ROM) with flexion to 120 degrees (normal 140) and extension to 5 degrees (normal 0).  Mild joint line tenderness was present without evidence of crepitus, joint effusion, or instability.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5010 (post-traumatic arthritis).  Members agreed 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).  As an alternate rating scheme, the persistence of pain after meniscal surgery warranted a 10% rating under code 5259 (cartilage, semilunar, removal of symptomatic).   There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), and no fracture, nonunion 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 rating higher than the 10% adjudicated by the PEB under any applicable 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 right knee condition.  

Left Hand Pain.  According to the STR and MEB NARSUM, the right-handed CI fell on his left hand in October 2003.  Extensive occupational therapy treatments produced minimal pain relief.  An X-ray on 8 July 2004 was unremarkable, and surgery was not recommended.  The MEB NARSUM examination noted complaints of left hand pain located specifically about the distal aspect of the fifth metacarpal bone (little finger side of the hand).  The painful symptoms made it difficult for him to do push-ups or grip and fire his weapon.  The PE revealed tenderness over the interspace between the fourth and fifth metacarpals as well as the distal portion of the fifth metacarpal.  Motion of the fifth metacarpal joint caused pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left hand condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing “occasional” and “slight” pain intensity IAW the US Army Physical Disability Agency pain policy.  Members agreed that the painful motion exhibited about the fifth metacarpal joint supported a 10% rating under VASRD §4.59 (painful motion).  After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel recommends a disability rating of 10% for the left hand condition.

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 left hand condition and IAW VASRD §4.71a, the panel recommends a disability rating of 10%, coded 5099-5003.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Posttraumatic Patellofemoral Arthritis, Right Knee	5010	10%	
Chronic Pain Left (Non-Dominant) Hand	5099-5003	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170221, w/atchs
Exhibit B.  Service Treatment Record

AR20190005976, 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.

Sincerely,					      
Enclosure