RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04155
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060725

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E8, General Engineering Supervisor, medically separated for “chronic right knee pain” and “chronic left elbow pain,” rated 0% each, with a combined disability rating of 0%.

CI CONTENTION:  “Please review all conditions.”  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 - 20060522	VARD - 20070410	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5003	0%	DJD, Right Knee	5010-5260	10%	20061024	
			Instability, Right Knee	5299-5257	10%	20061024	
Chronic Left Elbow Pain	5099-5003	0%	Bicipital Tendonitis, Left Elbow	5024-5206	10%	20061024	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 80%	
	
ANALYSIS SUMMARY:

Chronic Right Knee Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a right knee arthroscopy in May 2005 which included the removal of the medial meniscus. Despite post-surgical rehabilitation, the CI continued to have knee pain and occasional “locking up” of the right knee joint. The 7 April 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of significant discomfort to the right knee with walking prolonged distances, walking with a load or maneuvering stairs. The physical examination (PE) revealed tenderness about the right kneecap and the cooresponding joint line.

Right knee range of motion (ROM) testing showed 135 degrees of flexion (normal 140) and normal extension with pain. There was no evidence of local effusion, erythema, ecchymosis or bony crepitus. Clinical tests looking for joint instability were negative. The diagnosis was listed as severe right knee osteoarthritis.

At the 24 October 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported decreased motion and pain in the right knee most notabaly with frequent knee bending type activities. The PE revealed an altered gait which demonstrated a marked right limp with the right knee slightly flexed. Right knee ROM testing showed painful flexion to 90 degrees with normal extension. Clinical instability testing indicated a slight degree of ligament weakness (anterior drawer sign of +1). X-rays revealed mild changes of degenerative joint disease (DJD) of the medial compartment as well as on the articulating bony surface.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 0%, coded 5003 (degenerative arthritis), citing “full motion.” The VA dual rated the right knee condition 10%, analogously coded 5299-5257 (recurrent laxity or lateral instability), based on the C&P examination, citing positive anterior drawer sign; and 10%, dual coded 5010-5260 (traumatic arthritis causing limitation of leg flexion), based on the C&P examination, citing pain limited motion.

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). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under that code. The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI. There was no 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). After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel recommends a disability rating of 10% for the right knee condition.

Chronic Left Elbow Pain. According to the STR and MEB NARSUM, the right-handed CI developed left cubital tunnel syndrome and underwent left ulnar nerve transposition and left carpal tunnel release in August 2005. A clinical encounter dated 6 March 2006, 5 months prior to separation, noted normal ROM of both elbows. At the 4-month pre-separation MEB examination, the CI reported continued left elbow pain especially with activities such as push-ups. The left upper extremity PE was detailed and completely normal except for minimal decrease in ROM noting flexion to 135 degrees (normal 145), which was symmetrical and equal to ROM on the opposite upper extremity.  There was no comment with regards to painful motion.

During the C&P examination the CI reported a persistence of numbness or tingling of the left lateral forearm and lateral hand. The PE revealed painful and decreased ROM of the left elbow noting flexion to 105 degrees and normal extension. Pain about the left elbow was evidenced upon repetitive motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left elbow condition 0%, analogously coded 5099-5003, citing “full motion.” The VA rated the left elbow condition 10%, dual coded 5024-5206 (synovitis-forearm; limitation of flexion), based on the C&P examination, citing pain-limited motion. The panel agreed to place near exclusive probative value on the pre-separation MEB examination and therefore, absent evidence of significant limited motion, painful motion, ankylosis, joint fracture, or bony nonunion or malunion of the left elbow, no positive impairment rating is supported. After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the left elbow condition.

BOARD FINDINGS: In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a. In the matter of the left elbow 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.

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain	5003	10%	
Chronic Left Elbow Pain	5009-5003	0%	
	COMBINED	10%	

The following documentary evidence was considered:

	PD-2017-04155

AR20190011740, XXXXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX

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-2017-04155