RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02372
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Signal Support System Specialist, medically separated for “degenerative joint disease, left knee” 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 – 20061002	VARD - 20070227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Joint Disease, Left Knee	5003	10%	Musculoligamentous Strain with Degenerative Changes, Left Knee	5010-5260	10%	20070208	
History of Heart Palpitation	Not Unfitting	Heart Palpitations and Flutter	7011	0%	20070208	
Mild Adjustment Disorder	Not Unfitting	Adjustment Disorder	9440	0%	20070208	
Hypercholesterolemia	Not Unfitting	High Cholesterol	7099-7005	NSC	20070208	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee Degenerative Joint Disease.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent arthroscopic surgery with a partial synovectomy for loose body removal and a medial femoral condyle microfracture in November 2005.  An X-ray on 23 August 2006 revealed tri-compartment osteoarthritis.  
During the 22 August 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported constant left knee pain, throbbing in nature with a popping and cracking sensation.  Pain was aggravated by walking, running, prolonged standing, jumping, climbing or descending stairs.  Physical examination revealed tenderness and crepitus along the lateral and medial aspects and suprapatellar area.  There was pain with flexion and extension, but no limitation of motion.  The 23 August 2006 MEB NARSUM examination, noted complaints of continued pain, rated at 4/10, and the inability to tolerate any amount of impact activity.  Physical examination showed trace effusion and good quadriceps tone, as well as tenderness and crepitus.  Range of motion (ROM) measurements were recorded as flexion of 130 degrees (normal 140) and extension of 0 degrees (normal); painful motion was not addressed.

At the 8 February 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported that he underwent left knee surgery and, while five subsequent injections helped somewhat, he continued to have daily pain.  Physical examination showed a normal gait (with no use/need for an assistive device) and tenderness.  Flexion was to 130 degrees and extension to 0 degrees, with pain, but there was no additional limitation following repetitive use.  Left knee X-rays showed mild left patellofemoral and moderate medial compartmental degenerative changes.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (arthritis, degenerative), citing “X-ray findings, non-compensable limitation of motion.”  The VA also rated the left knee condition 10%, analogously coded 5010-5260 (arthritis, due to trauma-leg, limitation of motion) based on the C&P examination, citing objective evidence of painful motion.  Members agreed that there was no limitation of flexion of extension which supported a rating under codes 5260 or 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);  history of surgery to remove a meniscus (5259); or 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 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 Conditions:  History of Heart Palpitations, Mild Adjustment Disorder, and Hypercholesterolemia.  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 were profiled or implicated in the commander’s statement, and did not fail retention standards.  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 degenerative joint disease and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended history of heart palpitations, mild adjustment disorder, and hypercholesterolemia, 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 20170305, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180013340, 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