RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-03922
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021009

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Food Services Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “left knee pain” rated 10% with a disability rating of 10%.   

CI CONTENTION:  “I recently had a total left knee replacement, ORI, my disability rated knee.  I also received a rating for brain surgery…also had thyroid killed off…”  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 - 20050127	VARD - 20050202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5003	10%	Chondromalacia Left Knee	5299-5261	10%	20041104	
Adrenal Insufficiency	Not Unfitting	Adrenal Insufficiency	7911	20%	20041104	
Diabetes Insipidus		Diabetes Insipidus	7909	20%	20041104	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee pain began in 1997 following a twisting injury while attending basic training.  Knee X-rays were normal and MRI showed medial patellar chondromalacia but was otherwise normal.  The CI was separated in October 2002 and placed on the TDRL because her condition status post transphenoidal resection of a pituitary adenoma was not considered stable.  The left knee condition was adjudicated as unfitting at TDRL placement and rated 0% with application of the US Army Physical Disability Agency pain policy.   

At the 15 January 2003 VA Compensation and Pension (C&P) examination, 26 months prior to TDRL removal, the CI reported knee pain with squatting, stair climbing, and in cold weather; it was worse in the morning.  Bilateral knee range of motion (ROM) was “within normal limits.”  There was crepitus and tenderness to the lateral meniscus region of the left knee.  The CI was able to balance on the heels and toes, and she could tandem walk without difficulty.  

At the 5 November 2004 C&P examination, 4 months before TDRL removal, the CI reported a history of pain and stiffness with some swelling in the left knee without any history of instability or locking.  Physical examination revealed slight tenderness and pain.  Left knee flexion and extension were normal at 140 and 0 degrees, respectively, with “very minimal pain.”  Crepitus was associated with ROM, but no instability was noted.  

The 3 December 2004 NARSUM TDRL examination noted complaints of intermittent left knee pain, popping, and swelling, with worsening in the last 7 months.  The CI reported the pain was worse with kneeling, squatting, twisting, prolonged sitting, or walking up stairs.  Instability was reported when walking down stairs.  Treatment included physical therapy and nonsteroidal medication.  Physical examination showed a normal gait.  There was a mild effusion of the left knee and ROM showed a negative five degrees of hyperextension and flexion of 130 degrees.  There was a positive patellar grind test and medial joint line tenderness.  Testing for meniscal pathology was positive (McMurray’s) and there was no evidence of instability.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain condition 10%, coded 5003 (degenerative arthritis) at TDRL removal.  The VA also rated the chondromalacia left knee condition 10%, analogously coded 5299-5261 (limitation of extension of the leg) based on the 2003 C&P examination, citing consideration of functional limitation; the VA continued the 10% rating based on the 2004 C&P examination.  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).  The panel considered other VASRD knee and analogous codes, but all were less applicable and not advantageous for rating.   There was therefore no VASRD §4.71a route to a 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 left knee pain condition.  

Contended PEB Condition:  Adrenal Insufficiency (AI) and Diabetes Insipidus (DI).  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting at TDRL removal.  At the 24 September 2004 TDRL endocrine examination, 5 months prior to TDRL removal, the CI reported she had stopped taking the medications for her DI and AI.  She reported that she had to void during the night more than once and that on some days she did have increased urine volume, but not every day.  She also reported headaches that were not worse or changed in location.  Physical examination showed a normal appearance.  There was no evidence of AI or pituitary dysfunction.  There were no enlarged lymph nodes of the neck.  Testing showed a normal adrenal response to hormone stimulation (ACTH stimulation test), normal urine concentrating ability, and normal serum prolactin levels.  The endocrinologist concluded that the two conditions for which the CI was placed on TDRL no longer existed and the CI could be considered fit for active duty within the next year with regard to these conditions.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the left knee pain condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the contended adrenal insufficiency and diabetes insipidus conditions, 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.  

AR20190010909, 

	

Dear XXXXXXXXXXXXXXXX

	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.