RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05536
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061002

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Electrical Systems Journeyman, medically separated for “gastroesophageal reflux disease” and “right knee pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20060421	VARD - 20070416	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5003	10%	Right Knee PFS…	5260	0%	20070206	
GERD…	7399-7346	10%	GERD…with History of Irritable Bowel Syndrome	7319-7346	10%		
Abdominal Pain…due to IBS	Cat II					
Umbilical Hernia…		Status Post (S/P) Umbilical Hernia Repair	7399-7339	0%		
Chronic Low Back Pain (LBP)		Chronic Lumbar Strain	5237	10%		
Right Wrist Pain		S/P R Wrist Tendon Repair…	5215	0%		
Right Testicular Pain		Chronic Right Epididymitis	7599-7525	0%		
Cog. Dysfunction…Insomnia		Primary Insomnia	9499-9413	10%	20070212	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

GERD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was originally diagnosed with GERD in late 1999 and eventually underwent a Nissen surgical procedure for the same condition in March 2002.  Despite surgical intervention, dietary modification and medications, the CI’s adverse gastro-esophageal symptoms remained.  The 11 May 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of episodic flares of reflux.  The physical examination (PE) revealed no abnormalities under the gastro-intestinal and abdominal areas of focus.  At the 6 February 2007 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported continued difficulty with swallowing as well as heartburn.  He remained on medications for control.  Again, the PE, as focused to the abdominal examination, was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the GERD at 10%, coded 7399-7346 (analogous to hiatal hernia).  The VA also rated the GERD at 10% under the dual code of 7319-7346 (irritable bowel syndrome – hiatal hernia), based on the C&P examination.  Panel members first agreed that VASRD code 7346 (hiatal hernia) was most appropriate given the clinical diagnosis of GERD.  Additionally, the VASRD dictates the analogous coding of this condition to the primary condition of a hiatal hernia.  The difference between the 10% minimum rating and the next higher rating of 30% is a list of gastro-intestinal symptoms which are “accompanied by substernal or arm or shoulder pain.”  Although the CI subjectively had various gastro-intestinal symptoms, the higher rating criteria was not in evidence and therefore, was not supported.  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 GERD condition.  

Right Knee Pain.  According to STR and MEB NARSUM, the CI’s right knee pain began as early as January 1998 with no specific injury or trauma identified.  An MRI of the right knee performed on 9 January 2006, concluded the following: “probable torn medial meniscus.  Please correlate with PE findings and the [CI’s] symptomatology.”  The examiner, from a clinical encounter on 22 February 2006, documented that there was no clinical evidence of significant meniscal abnormality.   The MEB NARSUM examination noted continued complaints of right knee pain and discomfort which resulted in various activity restrictions.  The PE revealed tenderness about the right knee.  Active range of motion (ROM) was “full.”  

At the C&P examination, the CI endorsed intermittent (5-7 times per week) episodes of right knee pain described as crushing, aching and sharp.  He denied periods of incapacitation and the only treatment was anti-inflammatory medications.  The PE revealed normal ROM without pain.  Crepitus was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee at 10%, coded 5003 (degenerative arthritis).  The VA rated the right knee at 0%, coded 5260 (limitation of leg flexion), based on the C&P examination, citing “…MRI evidence of chondromalacia and crepitus…with full pain-free ROM.”  There was no limitation of motion in both pre-and-post separation examinations, which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating.  Although there was evidence of joint crepitus, such a finding is not in support of VASRD §4.59 (painful motion) and therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel agreed that a non-positive rating impairment was supported in this condition.  However, IAW DoDI 6040.44, the panel may not recommend a rating lower than that received prior to application.  The panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the right knee pain.  

Contended PEB Conditions:  Abdominal Pain, Umbilical Hernia, Chronic LBP, Right Wrist Pain, Right Testicular Pain, and Cognitive Dysfunction.  The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and none failed retention standards.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at or near 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, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the gastroesophageal reflux disease and IAW VASRD §4.76a, the panel recommends no change in the PEB adjudication.  In the matter of the right knee pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended abdominal pain, umbilical hernia, chronic low back pain, right wrist pain, right testicular pain and cognitive dysfunction, 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.  

SAF/MRB

Dear XXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05536.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.