RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03527
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Satellite Communication Systems Operator-Maintainer, medically separated for “bilateral knee pain” with a disability rating of 20%.  

CI CONTENTION:  “Knee issues have been progressively worse.  Diabetes is not controlled even with medication and has led to disabling nerve pain in feet.  Depression disorder has continued and must be controlled with [medication].  Hypertension has led to hospitalization.”  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 - 20080926	VARD - 20090429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain 	5099-5003	10%	Right Knee Patellofemoral Syndrome	5261	20%	20090122	
		10%	Left Knee Patellofemoral Syndrome	5261	10%	20090122	
Diabetes Mellitus	Not Unfitting	Diabetes Mellitus with Peripheral Neuropathy of the Feet 	7913	20%	20090122	
Diabetic Neuropathy Involving the Feet	Not Unfitting					
Major Depression	Not Unfitting	Depressive Disorder 	9434	30%	20090122	
Essential Hypertension	Not Unfitting	Hypertension	7101	10%	20090122	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral knee condition began in March 2008 without preceding trauma or injury.  On seldom occasions, the STR indicated the right knee as more painful than the left.  The 31 July 2008 physical therapy range of motion study showed flexion of the right knee to 90 degrees (normal 140) and flexion of the left knee to 110 degrees.  The 2 September 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of the inability to squat, wear body armor, walk long distances over uneven terrain or ruck march.  Physical examination (PE) revealed global tenderness about both knees without instability.  There was no comment with regards to ROM and or painful motion, although gait was normal.  

At the 22 January 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported severe pain and stiffness in both knees which occurred “weekly” and lasted for “hours.”  His functional impairment included a “decreased ability to ambulate long distances.”  The PE revealed decreased and painful motion of both knees.  Left knee ROM measured extension to flexion as 10-90 degrees and the right knee as 15-80 degrees.  His gait was documented as normal.      

The panel directs attention to its rating recommendation based on the above evidence.  The PEB rated the right and left knee conditions 10% each, coded analogously to 5003 (degenerative arthritis).  The VA rated the left knee at 10% and the right at 20% under code 5261 (leg; limitation of extension), citing limited motion.  Although the VA examination was closer to separation, the physical inconsistency of having a normal gait in the presence of limited knee extension to only 15 degrees is not physically possible and therefore, calls such ROM measurements into question.  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 bilateral knee condition.

Contended PEB Conditions:  Diabetes Mellitus (DM), Diabetic Neuropathy Involving the Feet, Major Depression and Essential Hypertension.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not separately unfitting.  Although the DM and diabetic neuropathy involving the feet were not implicated in the commander’s statement, both were judged to fail retention standards.  Clinical notes revealed the DM remained stable with dietary counsel and oral medications and the peripheral neuropathy was assessed as “subjective symptoms of peripheral neuropathy but no objective findings of peripheral neuropathy on clinical examination or electrophysiological examination.”  There was no performance-based evidence from the record that either condition significantly interfered with satisfactory duty performance at or near the time of separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for DM condition or the peripheral neuropathy of the feet, so no additional disability ratings are recommended. 

The major depression and essential hypertension were not profiled, implicated in the commander’s statement or judged to fail retention standards.  Clinical notes did not reveal any performance-based evidence that either condition significantly interfered with satisfactory duty performance at or near the time of separation.  Therefore, after due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for major depression or essential hypertension conditions, so no additional disability ratings are recommended. 

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended DM, diabetic neuropathy involving the feet, major depression and hypertension, 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 following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180009196, 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