RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05659
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090118

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:  Review 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 - 20081120	VARD - 20090712	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	Osteochondritis Dissecans, Left Knee	5099-5003	10%	20090319	
Post-concussive Headaches	Not Unfitting	Traumatic Brain Injury (claimed as Headaches)	8045	10%	20090319	
Mild Cognitive Difficulties	Not Unfitting					
Post Deployment Anxiety and Insomnia	Not Unfitting	PTSD and Major Depression (to include Insomnia)	9411-9434	30%	20090319	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s knee condition began in August 2007 after jumping off a helicopter during operations.  A left knee MRI showed an osteochondral defect, and in February 2008, a diagnostic arthroscopy revealed osteochondritis dissecans.  During the 9 September 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported left knee swelling and impaired use due to chronic pain.  The examiner documented full range of motion (ROM) of both knees, and the absence of pain.  There was a well-healed portal scar on the left knee and tenderness over the patellofemoral joint.  The 23 September 2008 MEB NARSUM examination, noted complaints of left knee pain, located above and around the knee cap, which increased with prolonged standing, walking, any impact activity, and bearing weight on the back and hips. Physical examination showed tenderness over the patellofemoral joint, and no effusion or instability.  Flexion was to 130 degrees (normal 140) and extension to 0 degrees (normal).  

At the 19 March 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported left knee osteochondritis dissecans with an intermittent course since onset, and no need for an assistive device for ambulation.  The examiner noted a normal gait, and recorded flexion to 130 degrees, with pain present at the endpoint of motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing painful motion.  The VA also rated the left knee condition 10%, analogously coded 5099-5003, based on the C&P examination, citing painful and limited motion of a major joint.  Panel members agreed there was no limitation of flexion or extension (5260 or 5261) for a compensable rating, however, there was evidence of painful motion with functional loss supporting 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); and 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).  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:  Post-Concussive Headaches, Post Deployment Anxiety and Insomnia, and Mild Cognitive Difficulties.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and did not 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.  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 left knee condition and IAW VASRD §4.59, the panel recommends no change in the PEB adjudication.  In the matter of the contended post-concussive headaches, post-deployment anxiety and insomnia, and mild cognitive difficulties, 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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXX:

	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