RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04309
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081023

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “right knee degenerative arthritis” and “right shoulder degenerative arthritis,” rated 10% each, with a combined disability rating of 20%. 

CI CONTENTION:  “I had more conditions in my health than I was rated for.”  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 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 - 20080718	VARD - 20091110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Degenerative Arthritis 	5003	10%	Right Knee Degenerative Arthritis	5010	10%	20090909	
Right Shoulder Degenerative Arthritis 	5099-5003	10%	Right Shoulder Degenerative Arthritis	5203-5010	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Right Knee Degenerative Arthritis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in 1997 from a fall after a parachute landing and then was reinjured while running in March 2007.  At a clinic examination on 16 October 2007, the CI reported chronic knee pain for more than 5 years.  On examination, the inferior pole of the patella was tender and a patella femoral grind test (Clarke’s sign) was positive, findings of which supported the assessment of patellofemoral pain syndrome.  X-rays on 2 January 2008 revealed a stable right knee without a fracture or dislocation, while an MRI the next day showed semimembranosus tendinopathy and an intrameniscal signal, but no frank tear.  Despite medication, a knee brace, a profile prohibiting running, and home exercises, the CI was unable to continue to work in his military specialty.  

The 29 January 2008 MEB NARSUM examination, 9 months prior to separation, noted complaints of constant pain, numbness, and arthritis of the knee with limitations of walking only 150 feet and standing for 20 minutes.  Physical examination showed pain on compression and anterior lateral joint line tenderness.  There was a tight lateral retinaculum.  Active right knee range of motion (ROM) was 0-105 degrees (normal 0-140) without notation of pain, while left knee ROM was 0-107 degrees.  On 24 April 2008, the CI was given a hinged knee brace.  During the June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported locking, pain, and numbness of the knee.  Physical examination noted the CI wore a knee brace.  

At the 1 October 2009 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported right knee pain, stiffness, weakness, incoordination, and locking several times a week.  He was able to stand for 15-30 minutes and walk more than a 1/4-mile, but less than a mile.  Physical examination showed a normal gait with no locking or instability.  Tenderness and an effusion were noted, as was a positive McMurray’s test (for meniscal tear).  An MRI was also suggestive of a small meniscal tear.  Right knee ROM was 0-90 degrees with pain following repetitive motion and no additional limitation on repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee degenerative arthritis condition 10%, coded 5003 (degenerative arthritis), citing limited ROM.  The VA also rated the same condition 10%, coded 5010 (arthritis, due to trauma, substantiated by X-ray findings), based on the C&P examination, citing painful or limited motion and VASRD §§4.40, 4.45, and 4.59.  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 VASRD §4.71a 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 right knee condition.  

Right Shoulder Degenerative Arthritis.  According to the STR and MEB NARSUM, the CI underwent right (non-dominant) shoulder surgery in August 2007 for an arthroscopic superior labral repair, subacromial bursectomy, and open clavicle resection (Mumford procedure).  X-rays of the right shoulder on 31 March 2008 were normal with the exception of the absence of the right distal clavicle, consistent with the prior surgery.  An MRI on 15 April 2008, ordered for persistent acromioclavicular pain and weakness in the rotator cuff, showed postsurgical changes of the distal clavicle, a full thickness tear at the anterior aspect of the supraspinatus with a partial undersurface tear more posteriorly, and a repaired superior labral tear anterior to posterior.   Despite physical therapy, he was unable to continue work in his specialty.  

The 30 April 2008 MEB NARSUM orthopedic addendum examination, 6 months prior to separation, noted complaints of chronic shoulder pain with throwing, overhead movement, and lifting (could only lift 5 pounds).  Physical examination recorded pain-limited ROM of flexion to 155 degrees (normal 180) with pain and abduction of 135 degrees (normal 180).  Additionally, there were indicators of painful motion (positive Neer’s and cross-body adduction signs).  During the June 2008 MEB examination, the CI reported shoulder pain from the surgery, a tear in his shoulder, and numbness.  Physical examination revealed decreased ROM and strength.  

At the C&P examination, the CI reported shoulder pain, stiffness, tenderness, weakness, and incoordination.  There were no locking episodes or flare-ups.  Physical examination showed pain-limited ROM of flexion to 120 degrees and abduction to 110 degrees, with no additional limitation after three repetitions.  An MRI from 14 April 2008 showed no appreciative changes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5003, citing limitation of motion.  The VA rated the condition 10%, coded 5203-5010 (impairment of clavicle or scapula-arthritis due to trauma), based on the C&P examination and citing painful motion. The VASRD §4.71a threshold for rating ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  There was no higher rating option than 10% under any other 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 right shoulder condition.  

BOARD FINDINGS:  In the matter of the right knee degenerative arthritis condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right shoulder degenerative arthritis 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.  

The following documentary evidence was considered:

AR20200002312 

Dear XXXXXXXXXXXXX:

	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.