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AF | PDBR | CY2013 | PD2013 02112
Original file (PD2013 02112.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1302112
BRANCH OF SERVICE: Army  BOARD DATE: 20140618
SEPARATION DATE: 20060119


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11C/Mortarman Gunner) medically separated for pain in his right knee, right shoulder, and right wrist. The CI injured his right knee during training in 2002 and 2004. The CI reported right wrist and shoulder pain following return from deployment. These conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or physical fitness standards, so he was referred for a Medical Evaluation Board (MEB). The MEB forwarded the diagnoses of “chronic right knee pain…” and “chronic right wrist and shoulder pain” to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded four other conditions (see rating chart below) for PEB adjudication. The PEB adjudicated “chronic right knee pain, meniscal tear, right shoulder pain and right wrist pain…” as unfitting in combination, rated 10%, referencing the US Army Physical Disability Agency (USAPDA) pain policy. The remaining conditions were determined to be not unfitting . The CI made no appeals and was medically separated.


CI CONTENTION: “Headaches, body aches, nightmares, and fit to work.” No further contention was submitted.


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB, when specifically requested by the applicant. The ratings for conditions meeting the above criteria are addressed below. In addition, the Secretary of Defense directed a comprehensive review of Service members with certain mental health conditions referred to a disability evaluation process between 11 September 2001 and 30 April 2012 that were changed or eliminated during that process. The applicant was notified that he may meet the inclusion criteria of the Mental Health Review Terms of Reference. The mental health condition was reviewed regarding diagnosis change, fitness determination and rating in accordance with VASRD §4.129 and §4.130. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Military DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations, and DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON :

Service IPEB – Dated 20051209
 VA - (10 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Right Knee Pain, Meniscal Tear, Right Shoulder Pain and Right Wrist Pain… 5099-5003 10% Residuals, Meniscal Tear, R Knee 5299-5257 0% 20061006
Any Disability of Right Shoulder Deferred
Residuals, Right Wrist Injury 5215 0%
Cognitive Disorder… Not Unfitting *Mild Cognitive Disorder…Post Traumatic Stress Disorder and Depression… 9304 50%* 20061129
Pain Disorder…
Dysthymia
Alcohol Dependence
No Additional MEB/PEB Entries
 Other x 12
Combined: 10%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 61101 .
* 20070112 VARD added rati ngs for mental health conditions .


ANALYSIS SUMMARY: The PEB combined the chronic right knee pain with meniscal tear, right shoulder pain and right wrist pain, without neurologic abnormality for a single 10% rating with application of the USAPDA pain policy. The approach by the PEB reflected its judgment that the constellation of conditions was unfitting and there was no need for separate fitness adjudications or implied adjudication that each condition was separately unfitting. The Board’s initial charge was to determine if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings. When considering a separate rating for each condition, the Board considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability. When the Board recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.
Chronic Right Knee Pain with Meniscal Tear. Service medical records showed that the CI injured his right knee during training in June 2002 and was diagnosed by orthopedic surgery as a sprain of the lateral collateral ligament. He reinjured the right knee during field training on 20 May 2004 when he fell and felt his right knee buckle. On examination in the emergency department, right knee movement was markedly limited due to pain and the examiner thought the knee might be locked due to a meniscus tear. The CI was referred to orthopedics and their 25 May 2004 evaluation noted findings indicative of a lateral meniscus tear and advised rest, further evaluation with magnetic resonance imaging (MRI), and follow-up at his home base. The records fall silent with respect to right knee pain and the CI passed his physical fitness test on 10 September 2004 completing the 2-mile run in 12 minutes, 15 seconds (attaining a maximum score). The CI deployed to Iraq with his unit in January 2005. On 19 February 2005, the vehicle he was driving hit an improvised explosive device (IED) and he struck his head on the roof of the vehicle. Medical documentation in the few weeks after that incident recorded a concussion and back pain radiating into the legs but made no mention of a right knee injury. A neurology examination on 22 February 2005 noted right shin pain. Air evacuation medical documentation on 7 March 2005, made note of “sports injuries to both knees as a child” without mention of re-injury. Air evacuation medical progress note on 10 March 2005 noted he was able to carry his own bags and climb stairs without difficulty (but reported back pain radiating into both legs). A neurology evaluation on 15 March 2005 noted a history of knee pain from high school sports and documented a normal gait. On 11 May 2005, the CI presented to the orthopedic clinic with a chief complaint regarding right arm pain and also mentioned “both of his knees are messed up.” The clinical focus was on the upper extremity complaints. On 30 May 2005, the CI presented to the emergency department with the complaint of acute onset of right knee pain. When he was turning around to get something in his car, he heard a pop and felt pain. On examination, there was no swelling but there was report of pain with motion and palpation. An X-ray of the right knee was normal. On follow-up with orthopedic surgery on 7 June 2005, the CI reported inability to fully extend the knee. On examination there was possibly a minimal effusion (fluid collection, “plus/minus”; effusion is typically seen with acute meniscus tears) and there was tenderness along the medial joint line. The orthopedist was skeptical there was an acute meniscus tear clinically. An MRI scan on 14 June 2005, of the right knee MRI showed a bucket handle tear of the lateral meniscus. At the 27 July 2005 orthopedic surgery evaluation, the CI right knee complaints included an inability to straighten the knee, 5-6/10 pain, weakness, locking, popping and instability. Physical examination showed no abnormal alignment, deformity and minimum effusion. There was tenderness along the medial and lateral joint line and pain laterally with McMurray’s test (assesses for meniscus problems). There was no instability of the right knee joint (varus/valgus instability and Lachman’s test and drawer test to assess functional integrity of the cruciate ligaments). Right knee range-of-motion (ROM) was extension to 0 degrees and flexion to 130 degrees (versus 0 and 140 degrees respectively for the left). The orthopedic surgeon found that based on history, exam and imaging studies, the CI had pathology consistent with a bucket handle tear of the lateral meniscus. He documented that the condition could likely be made better with surgery and counseled the CI regarding the surgical risks and benefits. The CI declined surgery and was therefore referred for MEB. The 21 November 2005 MEB narrative summary (NARSUM) documented physical examination findings from 12 August 2005. The right knee ROM in degrees by goniometer showed active flexion of 105 degrees and active extension of 10 degrees. Pain was elicited by flexion and extension.

The Board first considered whether the right knee condition, when considered independently, was separately unfitting for continued military service. All Board members agreed that the constellation of findings from the service medical records, radiographic reports and commander’s statement support a conclusion that the right knee condition was separately unfitting. The Board next considered its rating recommendation for the right knee condition at the time of separation. In addition to the evidence summarized above, the Board noted an insurance form (dated 11 October 2006) indicating the CI underwent right knee surgery on 20 July 2006 (6 months after separation) and reviewed the VA examination 9 months after separation. At the 6 October 2006 VA Compensation and Pension (C&P) examination, the CI reported he suffered a right knee injury during training. The CI complained of knee pain only if he made the wrong moves and he experienced no flare-ups. He denied buckling of the knees. Physical examination showed a normal gait without an assistive device. There was no pedal edema and all joints looked normal. Both knees demonstrated extension to 0 degrees and flexion to 140 degrees. The CI was capable of repetitive motion and ROMs were not additionally limited by pain, fatigue, weakness or lack of endurance. The examiner stated “Because there is absolutely no evidence for structural injury of the various claimed orthopedic disorders, this examiner has absolutely no diagnosis for any of the claimed orthopedic disorders, which are presently manifest only by subjective reporting of aches and pains and objective evidence of limitation of motion caused by painful motion.” The VA adjudicated a 0% rating for residuals, meniscal tear, right knee (coded 5299-5257; analogously to knee, other impairment of: recurrent subluxation or lateral instability) based on the 6 October 2006 VA C&P examination (VA rating decision on 1 November 2006). The limitation of motion documented in examinations did not attain a minimum rating under the 5260 (leg, limitation of flexion) or 5261 (leg, limitation of extension). The CI had a torn lateral meniscus with subjective symptoms of popping and locking. There was an episode of locking in May 2004 after which the CI recovered and subsequently passed the 2 mile run. A second episode occurred in June 2005 with minimal effusion. The CI declined surgical correction of the torn meniscus while in service but apparently underwent the surgery 6 months after separation with good outcome based on the VA C&P examination 9 months after separation. Based on evidence prior to separation, the torn meniscus would not attain a minimum rating under diagnostic code 5258 (dislocated meniscus with frequent episodes of locking). There was no instability for rating consideration under 5257 (recurrent subluxation or instability). Board members concluded that there was sufficient evidence of right knee pain to support a 10% rating based on painful motion (§4.59) or functional loss (§4.40) based on pre-separation evidence (coded 5299-5260).

Chronic Right Wrist Pain. The CI reported he suffered right sided orthopedic injuries from the 19 February 2005 IED blast exposure. On 19 February 2005, the vehicle he was driving hit an IED and he struck his head on the roof of the vehicle. Medical documentation in the few weeks after that incident recorded concussion and back pain radiating into the legs but made no mention of right wrist pain. Air evacuation medical documentation from March 2005 made no note of wrist injury or pain and an air evacuation medical progress note on 10 March 2005 noted he was able to carry his own bags without difficulty. The neurology examination on 15 March 2005 noted a past history of elbow fracture and complaint of “right arm cracking.” On examination, there was normal strength and sensation in all extremities. The first treatment record documentation of right upper extremity pain was a clinic note dated 22 March 2005, a month after the IED incident, when the CI complained of right forearm pain with rotation (pronation and supination). He reported that he had chipped the elbow just before he left Iraq and that it was swollen for a while. He noted there was cracking and popping of wrist with motion. On examination there was tenderness and reduced grip. At the 4 April 2005 occupational therapy evaluation, the CI complained of right wrist cracking/popping and pain that radiated to the elbow following the blast injury. He complained of constant, forearm to the elbow pain (5/10) at rest and sharp pain (6/10) when he picked things up. On physical examination there was popping at the joint between the two forearm bones (radius and ulna; radio-ulnar joint; involved in forearm rotation) adjacent to the wrist with active forearm rotation (supination and pronation). There was report of pain with active and passive supination (rotating the palm up) and tenderness to palpation in the region including parts of the adjacent wrist joint. Right hand grip strength was equal to the left hand (the dominant right hand would be expected to be a little stronger than the left). The CI presented to the orthopedic clinic on 11 May 2005 requesting a profile for his orthopedic problems since his unit was planning deployment (“needs profile - unit wants him to deploy with them to Iraq”). The CI reported his entire right upper extremity was painful and his right small finger was spontaneously crossing over his ring finger. On examination the CI held the small finger over the ring finger. The examination was otherwise unremarkable and the orthopedic surgeon’s observations led him to conclude the small finger motion was under voluntary control. Referral for electrodiagnostic studies of the right upper extremity nerves was made. X-rays performed on 11 May 2005 of the right upper arm, elbow, forearm and wrist were normal. The right hand was normal but did show an old injury (healed fracture) of the 5th metacarpal bone (bone in the palm of the hand attached to the small finger). At the 19 May 2005 occupational therapy evaluation, the CI complained of a shock-like sensation from the right elbow to the hand and wrist pain at the extreme limits of ROM. On physical examination, a deformity of the fingers was noted with the right small finger crossed on top of the ring finger. There was tenderness reported of the palmar side of the right wrist. Right wrist active ROM was documented as flexion of 80 degrees (normal 80), extension of 60 degrees (normal 70), radial motion of 15 degrees (normal 20) and ulnar motion of 30 degrees (normal 45). At the 23 May 2005 occupational therapy evaluation, the CI complained of constant 8/10 right wrist and elbow pain with rest and activity. A 26 May 2005 MRI scan of the right wrist was normal. The MRI study was augmented with injection of contrast into the joint (arthrogram). While the contrast injection was suboptimal, no abnormalities were revealed. Electrodiagnostic testing of the right upper extremity for nerve injury (nerve conduction velocity and electromyogram) on 7 July 2005 was normal (no evidence for peripheral nerve injury or spinal nerve injury). A 1 November 2005 occupational therapy evaluation documented the CI reported right wrist clicking with supination/pronation. He complained of pain with turning a doorknob where he felt 6-7/10 sharp pain at the right ulnar styloid (tip of ulna on small finger side of wrist). On examination, an audible pop was noted with active right wrist supination and pronation. ROM was recorded as right wrist extension/flexion of 50/70 degrees (compared to left wrist extension/flexion of 70/65 degrees). The 21 November 2005 MEB NARSUM documented no significant right wrist complaints or ROM. Repeat electrodiagnostic testing on 23 November 2005 was negative for focal neuropathy, plexopathy or radiculopathy. However electromyogram of the right hand “ADQ” muscle (abductor digiti quinti; small muscle on the side of the hand by the small finger that pulls the small finger away from the hand; not crossing over) demonstrated findings of chronic re-innervation consistent with a prior injury (correlates with the hand X-ray) and a cause for muscle spasm.

The Board considered whether the right wrist condition, when considered independently, was separately unfitting. The Board considered the persistent complaints of pain with use and examinations indicating popping and pain with motion and concluded there was not a preponderance of evidence to overcome a conclusion that the right wrist was not reasonably considered unfitting when considered separately from the other conditions. The Board next considered its rating recommendation for the right wrist condition at the time of separation. While subjective complaints of pain are documented, minimal evidence of a specific injury is reflected in the normal examinations and normal radiographic imaging in the weeks following the IED incident. The ROM documented in examinations did not attain a minimum rating under the VASRD codes for limitation of motion (5215 wrist and 5213 limitation of supination or pronation). The Board agreed that a 10% rating was supported based on painful motion (§4.59) or functional loss (§4.40) based on pre-separation evidence (coded 5299-5215).

Chronic Right Shoulder Pain. The CI reported he suffered right sided orthopedic injuries from a 19 February 2005 IED blast exposure. On 19 February 2005, the vehicle he was driving hit an IED and he struck his head on the roof of the vehicle. Medical documentation in the few weeks after that incident recorded concussion and back pain radiating into the legs but made no mention of right shoulder pain. Air evacuation medical documentation from March 2005, made no note of shoulder injury or pain and an air evacuation medical progress note on 10 March 2005 noted he was able to carry his own bags without difficulty. The neurology examination on 15 March 2005 noted a past history of elbow fracture and complaint of “right arm cracking.” There was no mention of shoulder symptoms. On examination, there was normal strength and sensation in all extremities. At the 11 May 2005 orthopedic appointment (over 2 months after the IED incident) the CI reported his entire right upper extremity was painful. The orthopedic surgeon listed joint pain localized to shoulder in his assessment and noted he could not explain the symptom. The 17 May 2005 orthopedic appointment made no mention of shoulder pain and contemporaneous occupational therapy encounters documented wrist and elbow symptoms. The physical profile report on 5 July 2005, listed right arm nerve damage and indicated referral for MEB. Electrodiagnostic studies performed on 7 July 2005 for evidence of nerve injury were normal. At the clinic appointment on 12 August 2005 for the MEB examination, the CI reported right shoulder pain since February 2005 located at the back of the shoulder. The pain was aggravated by certain motions (forward flexion and moving the arm across the chest) and with throwing (especially the release and follow through phase; the CI played baseball in college before entering service). On examination, the right shoulder abducted 150 degrees, flexed 170 degrees, extended 25 degrees, with external and internal rotation of 65 and 50 degrees respectively (by comparison, the left shoulder ROMs were 165, 175, 40, 80 and 85 respectively). There was report of pain at the back of the shoulder with flexion, abduction, and internal rotation. The CI reported a sensation of feeling like the shoulder would pop out with internal rotation. The initial physical therapy evaluation for complaint of shoulder pain on 26 August 2005 documented right shoulder “FAROM” (full active range of motion) with normal strength (5/5). There was pain with resisted external rotation. There was report of pain with the empty can maneuver suggestive of impingement of the supraspinatus tendon. The physical therapist advised a program of physical therapy for the shoulder. Records show physical therapy during September 2005, after which no further care for shoulder complaints is in evidence in the service treatment records. In the 21 November 2005 MEB NARSUM, the CI complained of right shoulder pain with motion. He reported that his right arm injury, from shoulder to wrist, was the result of his 19 February 2005 IED blast exposure. The history contained minimal subjective complaints regarding the right shoulder. The CI complained of a constant headache, which he believed to be secondary to his right shoulder pain. The constant pain was diminished with Tylenol. On examination, there was report of pain with shoulder motion in all directions. The CI reported that "it feels like it’s going to pop out" on internal rotation. The orthopedic PA measured right shoulder active ROM with a goniometer as follows: abduction 150 degrees, forward flexion 170 degrees, external rotation 65 degrees, internal rotation 50 degrees and extension 25 degrees. An MRI in March 2006 at the VA, 2 months following separation, was reported as normal.

The Board next considered whether the right shoulder condition, when considered independently, was separately unfitting. While an injury to the right upper extremity and right shoulder may have occurred at the time of the IED incident but was not documented because it was overshadowed by the initial attention to the concussion and back pain, the evidence indicates it was no more than mild and there was no evidence of a specific injury. The Board considered the subjective complaints of pain however it noted the normal examinations in the weeks following the IED incident and the normal MRI shortly after separation. The preponderance of evidence of findings from the service medical records and radiographic reports led the Board to conclude the right shoulder condition was not separately unfitting. The Board concluded therefore that this condition could not be recommended for separate unfit determination and disability rating.

Contended Mental Health Conditions. The Board considered the MH condition regarding appropriateness of changes in diagnoses and fitness determination in accordance with the special MH Review Project. The enlistment examination on 12 March 2002 noted a history of alcohol abuse and two arrests for alcohol at age 15 and 17. Service treatment records indicated evaluation or treatment for alcohol abuse in February 2002. The CI was deployed to Iraq from 25 January 2003 to 28 July 2003 and again January 2005 to February 2005. On 19 February 2005, he incurred a concussion when an IED blast caused him to strike his head on the roof of the vehicle he was driving. The neurology evaluation on 22 February 2005, recorded CI report of loss of consciousness for a “split second and awoke still driving.” Since that head injury he experienced problems with headache, decreased concentration, fatigue and occasional dizziness. A history of head injury playing high school football was noted (the air evacuation medical document on 20 February 2005 recorded a history of “severe” closed head injury as a teen from sports injury). The neurologic examination was normal. The 15 March 2005 neurology evaluation recorded similar information and examination findings. An occupational therapy note on 4 April 2005, recorded the odor of alcohol on his breath. According to the MEB psychiatry addendum for the MEB NARSUM, the CI was seen for an initial evaluation on 4 April 2005 by a staff psychiatrist at Division MH. At that evaluation, the CI complained of one and one half months of depressed mood, sleep disturbance (difficulty falling and staying asleep), poor concentration and a 20 pound weight loss. The CI reported a past psychiatric history, beginning in his senior year of high school, of "mood swings." He reported a 2-year history of low mood, irritability, anxiety, low energy, poor sleep, excessive dreaming, poor concentration, fast thoughts, difficulty sitting still, low self-esteem, and loss of sociability. The CI admitted he drank a lot of alcohol in high school and the first few years while he was in the Army. The diagnosis was listed as moderate recurrent depression and alcohol abuse in remission. The CI was treated with medications for mood and sleep disturbance. Over the three subsequent MH encounters (the last appointment on 2 May 2005), the CI reported that he was sleeping better and drinking a six pack of beer every other night. At the primary care clinic appointment on 29 July 2005, the CI reported he was sleeping well and had finished all treatments with behavioral health. A September 2005 performance counseling document stated the CI was performing well at numerous details and duties. At the 19 October 2005 neuropsychological evaluation, the CI reported his mood was "up and down ... no motivation." He complained of sleeping too much, poor energy and poor sex drive. The psychologist found the CI was cooperative, pleasant and polite and without anger or hostility. He had a flat affect and depressed appearance but did not appear overly suspicious, distrustful or paranoid. The CI showed no evidence of a thought disorder, psychotic process, delusions or hallucinations. His thinking was logical, coherent and goal-directed. He was alert and oriented with fair insight, fair judgment, and grossly normal cognitive function. The psychologist documented a Global Assessment of Functioning (GAF) of 58-60 (moderate symptoms) and a diagnosis of probable posttraumatic stress disorder (PTSD). Neuropsychological testing reflected a mild cognitive disorder. The psychologist noted the low average scores were likely similar to his academic performance before entering military service. A 3 November 2005 behavioral health appointment noted the CI was in trouble for missing unit formations. The CI was started on Antabuse for continued alcohol abuse (an alcohol antagonist drug which produces very unpleasant side effects when combined with alcohol). Depression was listed as in partial remission. A social work entry on 4 November 2005 recorded a complaint of angry outbursts. The CI’s mood was normal (euthymic) but concerned. A follow-up social work entry on 10 November 2005 recorded reports that the CI was doing well until 1 to 2 weeks prior to and was now experiencing difficulty sleeping, nightmares, anger and poor memory. On examination, there was appropriate mood, affect and verbalization. At the 10 November 2005 psychiatry MEB evaluation, the CI was enrolled in the Army Substance Abuse Program and taking Antabuse. According to the Clinician-Administered PTSD Scale, administered by the psychiatrist, the CI reported daily moderate to severe post-traumatic stress like symptoms. He complained of depersonalization, being dazed, difficulty concentrating, flashbacks, nightmares, being irritable, sleep disturbances, decreased sexual arousal and loss of interest in activities. However, the examiner also noted he was doing better with improved affect, did not look tired and denied suicidal or homicidal thoughts. The mood was normal (euthymic) with appropriate affect and normal interaction. The psychiatrist noted the history of depressive symptoms since high school (summarized above). The psychiatrist believed that the CI had been chronically depressed and much of what was being seen were probably traits that were lifelong characteristics. The diagnoses were dysthymia manifested by irritability, depression, "mood swing," low frustration tolerance, difficulty concentrating since high school; mild cognitive disorder and alcohol dependence. The psychiatrist indicated “non-applicable” with regard to service aggravation of the chronic depressive symptoms. The GAF was assessed as 70 (some mild symptoms; generally functioning pretty well). Although the psychiatrist indicated moderate impairment for further military duty due to dysthymia and mild impairment for duty for mild cognitive disorder, she documented that the CI met U.S. Army retention standards. His permanent profile, dated 30 November 2005, was S2 with dysthymia listed under functional limitations and capabilities. The commander’s statement noted the CI was a good soldier and indicated only physical limitations and did not address any MH limitations. A clinic note on 28 November 2005 noted the CI to be in a good mood with bright affect.

Dysthymia and cognitive disorder were referred into the DES and remained unchanged through the DES processing. Therefore the case does not meet the inclusion criteria in the Terms of Reference of the MH Review Project. The Board next considered the fitness of the MH condition regardless of actual diagnostic label based on a preponderance of evidence. The Board noted the chronic history of depressive symptoms and alcohol problems since high school and continuing while in service. The depressive symptoms and alcohol use problem worsened following return from deployment in March 2005 and the CI received treatment beginning in April 2005. By May 2005 symptoms were improved. The CI reported worsening symptoms in November 2005 with recurrent alcohol use. He was treated with Antabuse for the alcohol dependence problem. Subsequently his symptoms were noted to improve again. As noted above, the dysthymia or cognitive disorders were not implicated in the commander’s statement and were not judged to fail retention standards by the MEB psychiatrist. The Board determined that there was no performance based evidence from the record that any MH condition significantly interfered with satisfactory duty performance. The Board noted the VA MH C&P examination, 10 months after separation, recording CI reports of worsened symptoms and the diagnosis of PTSD. The Board concluded that information did not alter their assessment of the facts of the service treatment record before separation. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a determination of unfit for any contended MH conditions and therefore, no additional disability rating can be recommended.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. As discussed above, PEB reliance on the USAPDA pain policy for rating chronic right knee pain, meniscal tear, right shoulder pain and right wrist pain, without neurologic abnormality conditions was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the chronic right knee pain with meniscus tear condition the Board unanimously recommends a separately unfit determination with a disability rating of 10% coded 5299-5260 IAW VASRD §4.71a. In the matter of the right wrist pain without neurologic abnormality condition the Board unanimously recommends a separately unfit determination with a disability rating of 10% coded 5299-5215 IAW VASRD §4.71a. In the matter of the right shoulder pain condition the Board unanimously recommends a not unfit determination. In the matter of the contended MH conditions, the Board unanimously agrees that it cannot recommend it for additional unfitting disability rating. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Right Knee Pain With Meniscus Tear 5299-5260 10%
Right Wrist Pain, Without Neurologic Abnormality 5299-5215 10%
Right Shoulder Pain Not Unfit
Dysthymia Not Unfit
COMBINED
 20%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130124, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






                                   
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX , AR20140018977 (PD201302112)
1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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  • AF | PDBR | CY2013 | PD-2013-00776

    Original file (PD-2013-00776.rtf) Auto-classification: Approved

    The NARSUM conducted on 13 June 2007 (2 months prior to separation)documented constant pain rated 4/10 on average, exacerbated by “any increased activity, especially prolonged standing or walking up or down stairs.” The examiner further stated, “He denies any significant swelling of the knee, but states that it does lock up at least once or twice per day, with frequent popping.” Physical findings for the knee were not documented in the NARSUM, but measured ROM was flexion 128 degrees (normal...

  • AF | PDBR | CY2011 | PD2011-00614

    Original file (PD2011-00614.docx) Auto-classification: Approved

    Shoulders (Left and Right) Condition . In the matter of the “pain left elbow, left wrist, shoulders (bilateral), and left knee; (sleep disruption)” condition, the Board unanimously recommends that the left wrist condition and sleep disorder be determined as not unfitting, and that it be rated for multiple separate unfitting conditions as follows: left elbow condition coded 8616, rated 10% IAW VASRD §4.124a and VASRD §4.71a. Right Shoulder (Major) Pain with Recurrent...

  • AF | PDBR | CY2014 | PD-2014-01884

    Original file (PD-2014-01884.rtf) Auto-classification: Approved

    The TDRL’s re-evaluation IPEB adjudicated the right wrist, right knee and left shoulder as a single unfitting condition, rated at 20%. However, the PEB combined the condition of the right hand with the right knee and left shoulder and rated the conditions under the pain policy. In the matter of the left rotator cuff and left shoulder pain condition and IAW VASRD §4.71a, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.59 at both TDRL placement and...