RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05434
BRANCH OF SERVICE:  army	SEPARATION DATE:  20090715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “left knee pain” with a disability rating of 10%.   

CI CONTENTION:  “PTSD, Sleep Apnea, Degenerative Disk Disease, TBI.”  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 - 20090429	VARD - 20100104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain Following ACL Repair	5099-5003	10%	Strain Left Knee Status Post ACL Reconstruction with Residual Scars	5257-5019	10%	20090831	
Low Back Pain	Not Unfitting	Degenerative Disc Disease Lumbosacral Spine and Strain Thoracic Spine	5242	10%	20090831	
Mid Back Pain	Not Unfitting					
Adjustment Disorder	Not Unfitting	Post Traumatic Stress Disorder	9411	50%	20090928	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee surgery in April 2008 for torn anterior cruciate ligament (ACL).  The 16 December 2008 MEB NARSUM examination, 7 months prior to separation, noted complaints of persistent pain which were worse with cold weather, going up stairs (but not down), lifting with bent knees, squatting, running and extended walking.  Physical examination showed a normal gait, but there was tenderness.  A patellar grind test was negative, as were tests for instability.  There was no effusion, edema or ecchymosis.  The physical therapy ROM studies performed on 20 Jan 2009 showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal) with no appreciable change in ROM after three repetitions.  ROM testing was performed with a standard goniometer.  Limitation of ROM was secondary to pain. Pain did not cause interference with standing, sitting, or weight bearing of the left lower extremity.

The 28 September 2009 VA Compensation and Pension (C&P) evaluation (extracted from the 4 January 2010 VARD because the examination was not in the record), 2 months after separation, noted the CI experienced constant pain with popping.  Prolonged standing, sitting and weight bearing activities precipitated intermittent, weekly flare-ups with each episode lasting for 3 hours.  The gait was normal and ROM was flexion of 140 degrees with crepitus, popping and pain, and extension of 0 degrees.  There was a 10 degrees loss after repetitive use due to pain; there was no additional limitation of function after repetitive use due to fatigue, weakness, lack of endurance or incoordination.  There was no muscular atrophy, ligamentous laxity or instability, deformity, swelling or redness noted.  Motor strength and sensory functions were intact.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded analogously to 5003 (degenerative arthritis), citing painful motion.  The VA also rated the left knee condition 10%, dual coded 5257-5019, (other impairment of knee - bursitis), based on the C&P examination, citing limited and painful motion of a major joint.   

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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).  There was no applicable higher rating options than the 10% adjudicated by the PEB.  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 knee condition.  

Contended PEB Conditions:  Low Back Pain, Mid Back Pain and Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  Furthermore, the adjustment disorder is not a physical disability and is not ratable IAW DoDI 1332.38 (in effect at the time of separation).  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and 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 low back, mid back and adjustment 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:

Exhibit A.  DD Form 294, dated 20170608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007404 XXXXXXXXXXXXXXXXXX

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.

Sincerely,					      
Enclosure