RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03867
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was active duty E4, Combat Engineer, medically separated for “asthma” and “chronic right knee pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.   

CI CONTENTION:  “My conditions were increased by the VA after my release from active duty.  Other disability issues were not addressed.”  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 - 20060710	VARD - 20070724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Asthma	6602	10%	Asthma	6602	10%	STR	
Chronic Right Knee Pain	5099-5003	0%	Status Post Arthroscopy, Lateral Release…Right Knee	5260	10%	STR	
Combined Rating:  10%	Combined Rating of all VA Conditions:  20%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s asthma condition began in 2004 when he started having difficulty breathing during his last month of a deployment to Iraq.  A pulmonary function test (PFT) was ordered which showed mild obstructive disease, apparently with poor response to bronchodilators.  He was diagnosed with exercise-induced asthma and treated with Advair 250/50 mcg twice daily and albuterol inhaler as needed.  On 21 June 2005, repeat PFTs revealed an FEV1 of 95% and an FEV1/FVC ratio of 78%. 

The STR demonstrated a one-time prescription for an oral steroid on 14 June 2005 but no evidence of clinical encounters was found documenting the use of an oral or parenteral (injection) steroid for asthma during the year prior to separation.  There was no STR evidence that asthma exacerbations were frequent enough to require monthly visits to a physician.  At the time of the NARSUM examination 19 June 2006, the CI reported that he continued to have difficulty breathing and there was wheezing, mostly during strenuous physical activities and occasionally at rest.  He was using Albuterol once every 1-1/2 weeks.  He stated that he ran out of the Advair approximately 6 weeks prior, however, according to the pharmacy medication record, 9 December 2005 was the last time Advair 100/50 was issued.  At a primary care visit 31 August 2006, current medications listed were naproxen, Percocet, and Vicodin as needed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA each rated the asthma condition 10%, coded 6602. The PEB cited the CI was not using Advair that was initially prescribed, and was utilizing Albuterol only once or twice a week.  The VA citied FEV-1 of 71 to 80 percent of predicted value; or FEV-1/FVC of 71 to 80 percent; or intermittent inhalational or oral bronchodilator therapy.  

A 10% rating stipulates “intermittent inhalational or oral bronchodilator therapy.”  Panel members agreed that the PEB’s 10% rating was justified by the intermittent use of inhaled bronchodilator therapy reflected in the STR.  A 10% rating was also justified by the FEV-1/FVC of 74 percent, as noted by the MEB examination.  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 asthma condition.  

Right Knee.  According to the STR and MEB NARSUM, the CI’s right knee condition began in 2003, when he was hit with shrapnel while deployed to Iraq.  A knee MRI performed on 4 August 2005 revealed a Grade 2 sprain, partial tear of the insertion of the lateral collateral ligament in the lateral femoral condyle, and questionable small stress fracture of the tibial plateau.  On 14 September 2005, the CI underwent diagnostic arthroscopy and lateral release with pre- and postoperative diagnoses of right knee tight lateral retinaculum.  The CI did not improve after physical therapy, and on 24 January 2006, he underwent arthroscopy with pre- and postoperative diagnoses of right knee patellar maltracking and medial shelf plica syndrome.  

During the 8 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, physical examination revealed full ROM and 5/5 motor strength.  The 19 June 2006 MEB NARSUM examination, noted complaints of right knee pain that averaged 2 to 3 on a scale from 1 to 10, and went up to 6/10 with physical activity, such as going up and down stairs, prolonged standing, walking, or any strenuous physical activity.  He also had intermittent swelling, a feeling of popping, giving way, and catching.  Physical examination showed a normal gait, swelling and tenderness.  He had a negative McMurray, and a positive 1A Lachman.  The right knee ROM was flexion of 120 and extension of 0 degrees, not limited by pain.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing no joint instability or loss of motion.  The VA rated the right knee condition 10%, coded 5260 (leg, limitation of flexion), based on the STR, citing leg flexion that was limited to 45 degrees.  

There was no evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The panel considered other VASRD knee and analogous codes, but all were less applicable and not advantageous for rating. No additional functional limitation was evidenced by the examinations.  Therefore the panel concluded there was insufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  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.  

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.97, the panel recommends no change in the PEB adjudication.  In the matter of the right knee 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. 

AR20190010864, XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXX:

	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.