RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04413
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090924

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E1, Trainee, medically separated for “chronic right knee pain” and “left foot injury,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  “I have not gotten any better and probably won’t get better.”  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 - 20090911	VARD - 20100804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	Right Knee Degenerative Joint Disease 	5299-5010	10%	20100621	
Left Foot Injury	5284	10%	Left Cuboid Stress Fracture	5284	10%	20100621	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in May 2009 without trauma or injury.  
The 6 August 2009 MEB NARSUM examination, 1 months prior to separation, noted complaints of right knee pain which increased with walking and impact activities.  Physical examination showed right knee and proximal tibia tenderness.  The range of motion (ROM) study showed right knee extension of 0 degrees (normal) and flexion of 110 degrees (normal 140), without pain.

At the 21 June 2010 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported right shin, calf, and knee pain.  Physical examination showed tibia and calf tenderness.  The ROM study showed right knee extension of 0 degrees and flexion of 110 degrees, with pain.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion.  The VA rated the right knee condition 10%, analogously coded 5299-5010 (arthritis due to trauma), based on the C&P examination, citing painful motion.

The panel agreed 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 sufficient STR evidence of painful motion with functional loss to support 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.  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 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.

Left Foot Injury.  According to the STR and MEB NARSUM, the CI’s left foot condition began in March 2009 without trauma or injury.  The MEB NARSUM examination, 1 month prior to separation, noted complaints of left foot pain which increased with walking and weight bearing activities.  Physical examination showed an abnormal gait favoring the left side.  There was tenderness along the left cuboid bone (foot bone).  Left ankle dorsiflexion was 15 degrees (normal 20) and plantar flexion was 40 degrees (normal 45).  There was no painful motion, crepitus or locking.

At the C&P examination the CI reported left foot pain with weakness, stiffness and swelling.  Physical examination showed tenderness of the left ankle, fifth metatarsal area and longitudinal arch.  Left ankle dorsiflexion was 0 degrees and plantar flexion was 40 degrees; painful motion was present.  There was no additional loss of ROM due to incoordination or instability after repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, coded 5284 (foot injuries, other), citing limitation of motion and moderate injury.  The VA also rated the left foot condition 10%, coded 5284, based on the C&P examination, citing moderate symptoms.

The panel agreed there was no evidence to support a 20% moderately severe foot injury as recorded by the MEB NARSUM and VA examinations proximate to separation.  The panel also considered code 5279 (metatarsalgia) for foot pain, but the maximum rating is 10% which provides the CI no rating advantage.  IAW VASRD §4.7 (the higher of two evaluations) the panel considered a rating under code 5271 (ankle, limited motion).  Although the VA examination recorded dorsiflexion of 0 degrees, the preponderance of STR ankle ROM evidence did not support marked limitation of motion of the left ankle.  After due deliberation, considering all of 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 foot condition.

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

AR20180016688, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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.