RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04133
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080613

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Explosive Ordnance Disposal Specialist, medically separated for “degenerative osteoarthritis of the left knee” with a disability rating of 0%.

CI CONTENTION:  “I was rated with the VA at 30%.”  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 - 20080225	VARD - 20080723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Osteoarthritis of the Left Knee	5003	0%	Left Knee Degenerative Joint Disease	5003-
5260	10%	20080414	
Right Shoulder Pain	Not Unfitting	Right Shoulder Strain	5201	10%	20080414	
Irritable Bowel Syndrome (IBS)	Not Unfitting	IBS with Gastroesophageal Reflux Disease (GERD)	7319	10%	20080414	
Gastroesophageal Reflux Disease	Not Unfitting					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Degenerative Osteoarthritis of the Left Knee. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed left knee pain in late 2005 attributed to rigorous training requirements. An MRI on 26 July 2006 was normal, with intact ligaments and menisci, and there was no evidence of subsequent injury. He was diagnosed with patellar maltracking and underwent an arthroscopic lateral release in February 2007, 16 months before separation and the only surgery.  There was ample documentation in post-operative STR entries

of normal (or nearly so) range of motion (ROM). An entry after full recovery documented flexion to 130 degrees (normal 140) and extension to 0 degrees (normal). Remaining entries noted grossly normal ROM, but some confirmed painful motion. There was ample documentation of the absence of persistent effusion, instability, or meniscal impingement (locking). There was, however, note of a persistently antalgic gait and use of a cane.

The 16 November 2007 MEB NARSUM examination, 7 months prior to separation, documented constant diffuse left knee pain rated 3-9/10 that was aggravated by running and other impact activities, negotiating stairs, and prolonged walking (20 minute tolerance). The physical examination recorded use of a cane (no description of gait), patellar tenderness, no effusion, instability, or impingement, and grossly normal ROM without note of painful motion.

At the 14 April 2008 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI stated that his knee was “much worse” since surgery with “swelling and giving way” that limited walking to 15 minutes. The physical examination recorded “limping on his left leg” with use of a cane, no instability or impingement, and no note of tenderness or effusion. Measured ROM was normal for flexion and extension, but the examiner noted onset of pain at 45 degrees flexion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 0%, coded 5003 (degenerative arthritis), citing “no mechanical loss of motion” (suggesting criteria of Army Regulation 635-40 [B-29, e]). The VA rated the condition 10%, coded 5003-5260 (degenerative arthritis rated for limitation of flexion) based on the C&P examination proximate to separation and citing painful motion.

There was no ROM limitation in evidence to support the minimum 10% criteria under codes 5260 or 5261 (limitation of extension). Panel members agreed, however, that there was satisfactory evidence of painful motion from both the service evidence (STR provider entries) and pre- separation C&P to support a minimum 10% rating IAW VASRD §4.59. There was no evidence of frequent locking with recurrent effusions (code 5258), 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 were no other criteria in evidence to support a rating higher than 10% under any applicable VASRD §4.71a code. After due deliberation, considering all evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for the left knee condition under code 5010-5260 (arthritis due to trauma rated for painful flexion).

Contended PEB Conditions: Right Shoulder, IBS, and GERD. The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting. None of the conditions were profiled, all were judged to meet retention standards, and none were implicated in the commander’s performance statement. There was no performance-based evidence from the record that any of them 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 these conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5010-5260 IAW VASRD §4.71a. In the matter of the contended right shoulder, irritable bowel, and gastroesophageal reflux 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.

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Traumatic Arthritis with Surgical Residuals	5010-5260	10%	

The following documentary evidence was considered:

PD-2017-04133

AR20190012043, XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

PD-2017-04133