RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05525
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20051025

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “chronic right knee pain and instability,” with a disability rating of 0%.   

CI CONTENTION:  “Review of all conditions.”  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 - 20050929	VARD - 20060302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain and Instability	5099-5003	0%	Right Knee Condition	5260	NSC	20051021	
Migraine Headaches with Aura	Not Unfitting	Migraine Headaches	8100	0%	20051021	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain and Instability.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a diagnostic arthroscopy to evaluate the right knee condition in June 2004, but no surgical solution was determined.  The 21 April 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of pain with activity.  Physical examination showed range of motion (ROM) of the bilateral knees as extension (hyperextension) of -20 degrees (normal 0) and flexion of 140 degrees (normal).  There was laxity and a grade 1A Lachman with a firm endpoint which was symmetric bilaterally.  There was a grade 1 posterior drawer which was symmetric bilaterally.  There was no varus or valgus instability at 0 and 30 degrees of flexion of the knees.  There was no medial joint line tenderness, patellar tenderness or pain on patellar compression.  

At the 21 October 2005 VA Compensation and Pension (C&P) evaluation, 4 days before separation, showed a normal gait without effusion, locking, pain, subluxation or crepitus.  ROM testing showed flexion of 0-140 degrees without pain.  There was no additional limitation of motion of the right knee due to fatigue, weakness, lack of endurance or incoordination.  Testing for ligamentous instability or meniscal pathology were negative.  X-rays were negative.  The examiner indicated the CI had a normal right knee with no current objective findings to render a diagnosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded analogously to 5003 (degenerative arthritis), citing normal gait, a 1A Lachman’s and grade 1 posterior drawer sign, ROM measured as -20 to 140 degrees, with globalized laxity in all joints and unremarkable radiographic studies.  The VA determined the right knee condition was not service-connected.  

The panel majority notes that after an MRI and an arthroscopy, no anatomical basis for her knee pain was found and no documented objective findings of pain were demonstrated during the NARSUM and C&P examinations.  The VA found a generalized laxity in the CI’s ligaments and attributed her symptoms to a congenital condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

Contended PEB Condition:  Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 10% but elected not to submit a minority opinion.  In the matter of the contended migraine headaches, the panel recommends no change from the PEB determination 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 20170420, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007407 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