RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-01372
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20050506

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Military Policeman, medically separated for “chronic pain of the left knee,” rated at 0%.

CI CONTENTION:  He believes his condition deserved a higher rating.  His complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule For Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

SERVICE PEB - 20050321	VARD - 20050722  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain 	5099-5003	0%	Left Patella Tendonitis	5299-5024	10%	20050404	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in September 1998 without specific injury.  Radiographic studies showed patellar tendonopathy with mild degenerative disease.  There was no surgical indication.  Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  

At the MEB NARSUM, dated 5 October 2004, 7 months prior to separation, the CI reported that his knee condition was worsened with sports, prolonged sitting, or going up and down stairs and that it was “occasionally associated with mild swelling.”  On examination there was no crepitus and examination tests for ligamentous instability/laxity and meniscus pathology were negative.  His bilateral knee ROM was slightly limited and had moderate tenderness over his patellar tendon.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 6 December 2004, 5 months prior to separation, the CI reported that he had a swollen and painful knee that sometimes locked or gave out due to pain and that he wore a knee brace.  At the time of the physical therapy clinic appointment on 6 March 2005, 2 months prior to separation, the CI reported that he had had chronic left knee pain since basic training and that his knees buckled when he knelt down. The CI denied swelling or locking.  On examination he was noted to have ROM that was pain-free, but limited with minimal guarding, as indicated in the chart above.  At the VA Compensation and Pension (C&P) examination on 4 April 2005, a month prior to separation, the CI reported that his left knee pain manifested while “climbing up and down stairs, after prolonged sitting or immobilization, and after running and other vigorous activities.”  Physical exam showed positive crepitus, but examination tests for ligamentous instability/laxity and meniscus pathology were negative.  He had a full weight-bearing non antalgic gait and his ROM was limited with an additional functional loss of flexion to 110 degrees after repetitive movements.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing full ROM.  The VA rated the left knee condition 10%, coded 5299-5024 (analogous to tenosynovitis), citing flexion limited by pain.  There was no limitation of flexion or extension that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), frequent locking with effusions or any indication of dislocated meniscus or loose body (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40, and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left knee condition, coded 5099-5003.  

BOARD FINDINGS: In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Left Knee Pain	5099-5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140317, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX, AR20160005899 (PD201401372)

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,
accept the Board's recommendation to modify the individual's disability rating to 10%
without re-characterization 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:

CF:
( ) DoD PDBR
( ) DVA