RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-04803
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Field Artillery Automated Tactical Data Systems Specialist, medically separated for “left knee pain” with a disability rating of 10%.  

CI CONTENTION:  Requested review of the left knee, left shoulder, hypertension, post-traumatic stress disorder (PTSD), and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20051209	VARD - 20060921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5003	10%	Left Knee Chondromalacia with Degenerative Joint Disease	5010-5260	10%	20060728	
Chronic Left Shoulder Pain	Not Unfitting	Left Shoulder Strain	5201	20%		
Hypertension		Hypertension	7101	10%		
Major Depressive Disorder, with Associated Insomnia, Anxiety and Possible Mild PTSD		PTSD with Depression, Anxiety and Insomnia	9411	30%	20060718	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee pain began in March 2001 during basic training when he stepped into a hole while on a march.  He reinjured the knee and was treated multiple times with full recovery, until May 2005 when he twisted it playing basketball.  He was unable to bear weight and after an emergency room evaluation, he was on crutches for approximately 2 months.  A left knee MRI in May 2005 and showed a large bone bruise over the lateral femoral condyle as well as degenerative changes.  Left knee X-rays later that month showed degenerative changes with a possible very small osteochondroma (benign bone growth).  Despite physical therapy from May-August 2005, he had no significant relief or improvement.  

During the 18 October 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI wore an elastic knee support and reported constant knee pain with swelling at times, and giving out.  Physical examination showed painful left knee motion without edema or point tenderness.  At the MEB orthopedic consultation on 26 October 2005, the CI reported left knee pain, swelling, and intermittent giving way for 2 years.  Physical examination showed a normal gait and left knee range of motion (ROM) from 0-120 degrees (normal 0-140).  Strength was normal, and there was significant tenderness about the patellofemoral joint and lateral femoral condyle, without effusion, and no evidence of instability. 

The 23 November 2005 MEB NARSUM examination, 1 month before separation, noted CI complaints of knee pain, rated at 3/10, with frequent flares rated at 7-8/10.  He had occasional swelling around the knee, and although he took an anti-inflammatory medication daily for pain, he never had full relief.  The examiner cited the MEB Form 2808 and orthopedic examinations for physical findings.  

At the 28 July 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported left knee pain without any weakness, stiffness, swelling, heat, redness, giving away, lack of endurance, locking, fatigability, or dislocation.  He was unable to stand or walk for long periods, but denied incapacitation, and had fair results with pain medication.  Physical examination showed normal gait and posture with no requirement for an assistive device for ambulation.  There was left knee tenderness and ROM was from 0-100 degrees after repetition, with pain at end range of flexion.  There was increased pain after repetition, with no additional loss of motion, and no evidence of instability or meniscal pathology.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (arthritis, degenerative), citing a major joint with radiographic evidence of degenerative joint disease and slight loss of motion.  The VA also rated the left knee condition 10%, but dual coded 5010-5260 (arthritis, due to trauma-leg, limitation of flexion of), based on the STR and C&P examinations, citing painful and limited motion of a major joint.  Panel members agreed there was no limitation of flexion or extension (5260 or 5261) which supported a compensable rating, however, there was evidence of painful motion with functional loss warranting 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); history of surgery to remove a meniscus (5259); 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 was therefore no rating higher than 10% supported under any applicable VASRD 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 condition.  

Contended PEB Conditions: Chronic Left Shoulder Pain, Hypertension, and Major Depressive Disorder (MDD) with Associated Insomnia, Anxiety and Possible Mild PTSD.  The panel’s main charge is to assess the fairness of the PEB’s determination that the condtions were not unfitting.  
The left shoulder condition was implicated in the commander’s statement dated 17 October 2005, but was given a permanent U2 profile and did not fail retention standards.  A “2” profile designation indicates a condition which requires some physical limitations, but is not in all cases disqualifying for continued military service.  There was no performance-based evidence from the record the shoulder condition significantly interfered with satisfactory duty performance at separation.  The hypertension and major depressive disorder were not profiled or implicated in the commander’s statement and did not fail retention standards.  There was no performance-based evidence from the record the conditions 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 determinations for the left shoulder pain, hypertension and MDD, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended chronic left shoulder pain, hypertension, and major depressive disorder with associated insomnia, anxiety and possible mild post traumatic stress disorder, 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.  

The following documentary evidence was considered:

		PD-2017-04803

[AR NUMBER], XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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.

Enclosure

	PD-2017-04803