RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-03367
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061110

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O2, Psychiatric Nurse, medically for “chronic pain, right leg, status post tibial plateau fracture, healed” with a disability rating of 10%.

CI CONTENTION: Review requested 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 - 20060411	VARD - 20060420	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Leg…	5099-
5003	10%	Residuals, Right Tibial Plateau Fracture with Mild Degenerative Joint Disease	5311-
5262	10%	20051222	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic Right Leg Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI fractured her right leg below the knee in 2002 while traversing an obstacle course. She re-injured the leg (same area) in 2004, but it was not considered to be a re- fracture. Subsequent residual pain kept her from performing required physical training, but she was able to continue working in her occupation as a nurse.

At the 22 December 2005 VA Compensation and Pension (C&P) examination, 11 months prior to separation, the CI reported intermittent flare-ups of right knee pain occurring once per week with a duration of 1-2 days. She endorsed right knee swelling and redness especially associated with “military training.” The physical examination (PE) revealed decreased and non-painful right knee range of motion (ROM) with flexion to 118 degrees (normal 140) and extension to 0 degrees (normal). There was no evidence of abnormal joint motion, deformity, instability or local infection. An X-ray revealed “very mild degenerative changes,” and the diagnosis was listed as “right tibial plateau fracture, reinjured in 2004; with mild degenerative joint disease.”

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right leg condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy. The VA also rated the right leg condition 10%, but dual coded 5311-5262 (muscle Group XI; propulsion, plantar flexion of foot-tibia/fibula impairment), based on the C&P examination, citing VASRD criteria. The case file contained a paucity of clinical records near the time of separation and therefore, complete probative value was proportioned to both the NARSUM and VA exams at 10 and 11 months prior to separation. Panel members agreed that no greater than a 10% rating was supported in either in the probative examinations, noting both X-ray evidence of degenerative changes and painful motion of the right knee joint. 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 leg condition.

BOARD FINDINGS: In the matter of the right leg condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. 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:

	PD-2017-03367
, XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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.

Enclosure

	PD-2017-03367