RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04952
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050124

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Light-Wheel Vehicle Mechanic, medically separated for “chronic right knee pain” and “bilateral high frequency sensorineural hearing loss,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20041201	VARD - 20050617	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Patellofemoral Syndrome, Right	5260	10%	20050518	
Bilateral High Frequency Sensorineural Hearing Loss	6100	0%	Bilateral Hearing Loss	6100	0%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

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 June 2003 after a twisting injury while running. Knee X-rays in October 2003 and an MRI in December 2003 were normal. Physical therapy did not  alleviate  the knee pain  and  no other treatments  were recommended.  The  15 October 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic right knee pain. Physical examination showed tenderness of the back of the knee, medial joint line and medial collateral ligament, and a positive patellar grind test, but no effusion or instability. Knee range of motion (ROM) measurements revealed flexion of 120 degrees (normal
140) and extension of 0 degrees (normal). At the MEB examination (recorded on DD Forms 2807- 1 and 2808), 3 days later, physical examination showed a positive apprehension test, but no instability and normal strength.

There was no VA Compensation and Pension (C&P) examination proximate to separation in evidence, but at an outpatient VA orthopedic evaluation on 18 May 2005, 4 months after separation, the CI reported right knee pain and giving way. Physical examination showed mild meniscal pathology and some pain over the patellar tendon and along the medial and lateral joint lines, but no evidence of instability. The CI was very apprehensive with any type of motion. Active knee ROM was from approximately 5-90 degrees.  Knee X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, analogously coded as 5003 (degenerative arthritis), citing rated as “slight/frequent” with likely application of the US Army Physical Disability Agency (USAPDA) pain policy. The VA also rated the right knee condition 10%, coded 5260 (limitation of flexion), based on the STR and outpatient VA notes, citing painful motion. Panel members agreed that there was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) documented at the MEB NARSUM or VA examinations. There likewise was no compensable limitation flexion or extension (5260 or 5261); 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). No additional functional limitation was documented by the examinations, and thus the panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB. Panel members noted the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating and therefore, no change to the PEB’s coding choice is recommended. 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 pain condition.

Bilateral High Frequency Sensorineural Hearing Loss. According to the STR and MEB NARSUM, the CI’s bilateral hearing loss was noted during the 18 October 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), with an audiogram showing high frequency hearing loss in both ears. At an audiology examination on 29 October 2004, 3 months prior to separation, the CI reported concern for his hearing with intermittent tinnitus in the right ear and dizziness. Physical examination of the ears was normal with some blood visible in the right external auditory canal, but without active bleeding. Audiometry showed right ear hearing level of 45 decibels (dB) at 1000 hertz (Hz), 55 dB at 2000 Hz, 50 dB at 3000 Hz and 50 dB at 4000 Hz with an average hearing loss of 51 dB. The left ear hearing level showed 50 dB at 1000 Hz, 50 dB at 2000 Hz, 45 dB at 3000 Hz and 45 dB at 4000 Hz with and an average hearing loss was 48 dB. Speech discrimination was 100% in both ears. There was no VA C&P examination proximate to separation in evidence.

The hearing examination which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

HEARING	EXAM	MEB  ~5 Mo. Pre Sep	

LEFT EAR	Average Hearing Loss	48dB	
	Speech Discrimination	100%	
	Table VI / VIa	/ I	

RIGHT EAR	Average Hearing Loss	51dB	
	Speech Discrimination	100%	
	Table VI / VIa	/ I	
§4.85 RATING	Table VII	0%	

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral hearing loss 0%, coded 6100 (hearing loss) based on the 29 October 2004 audiology examination with audiogram. The VA also rated the bilateral hearing loss condition 0%, coded 6100 (hearing loss), based on the same audiology examination, citing average dB losses of 51 in the right ear and 48 in the left ear, with speech discrimination of 100 percent   in

the right ear and 100 percent in the left ear.   According to the procedures specified    by VASRD
§4.85 (evaluation of hearing impairment), the Roman numeral designation obtained from Table VI “Numeric Designation of Hearing Impairment Base on Puretone Threshold Average and Speech Discrimination” was I in both ears based on the audiology examination (October 2004 audiogram). Applying the Roman numeral designations of the right and left ears (both I) to Table VII (percentage evaluation for hearing impairment) provides a final rating of 0% for hearing impairment. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded t there was insufficient cause to recommend a change in the PEB adjudication for the bilateral hearing loss.

BOARD FINDINGS: In the matter of the chronic right knee pain condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication. In the matter of the bilateral hearing loss and IAW VASRD §4.85, 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.

 Dear XXXXXXXXXXXXXXXX:
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.

Sincerely,

Enclosure