RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02237
BRANCH OF SERVICE:  Army	DATE OF SEPARATION:  20020329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee - Artillery Mechanic, medically separated for “chronic pain left knee, due to contusion,” with a disability rating of 0%.  

CI CONTENTION:  “Please consider all conditions.”  The complete submission is at Exhibit A.  

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 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/Naval 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 - 20020314	VARD - 20020402	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Knee	5099-5003	0%	Residual Traumatic Contusion Left Knee	5260	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain Left Knee.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in September 2001 when he sustained a traumatic contusion to the left knee during training.  An initial magnetic resonance image (MRI) showed effusion and a bruise to the femoral bone.  Orthopedic evaluation concluded with a diagnosis of contusion to the left knee.  Surgery was recommended as a possibility, but not performed.  

Despite treatment, the CI’s knee condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and was referred for an MEB.  An MRI done in November 2001 suggested a possible anterior cruciate ligament tear and degenerative change in the posterior medial meniscus (semi-lunar cartilage).  Treatment notes between October and November showed continued complaints of knee pain, and an orthopedic evaluation done on 19 November 2001 showed no effusion, with examination tests for ligamentous instability and meniscus pathology negative.  At the MEB examination dated 8 February 2002, 2 months prior to separation, the CI reported he could walk and move better but did not have full flexion, and it hurt to stand.  There were no complaints of locking or giving way, and the range-of-motion (ROM) was mildly limited in flexion.  On examination, the CI could walk, sit and stand well.  ROM flexion was 130 degrees (normal 140) and extension 0 degrees (normal 0).  There was no, tenderness, effusion, crepitus, ligamentous instability or signs of meniscus (semi-lunar cartilage) pathology or impingement.  

No VA Compensation and Pension (C&P) examination was conducted proximate to separation.  C&P exam from 2015 was in evidence and indicated the CI underwent left knee surgery in May 2003 (over a year after separation) for meniscus repair.  

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 arthritis), citing the US Army Physical Disability Agency pain policy (AR 635-40) for slight/intermittent pain.  The VA rated the left knee condition 10% (coded 52602, limitation of flexion), citing painful limiting motion, and based the rating on service treatment records and the MEB examination.  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) to support a rating under the respective codes.  

Since there was sufficient evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) and insufficient evidence for either dual coding of the knee or any rating higher than 10%, the Board discussed the most appropriate coding for the 10% rating.  Given the femoral contusion, analogous rating was considered under code 5255 (femur, impairment) as “slight knee disability” (10%), and given the radiographic evidence of meniscal pathology (with post-separation surgery) alternate coding analogous to 5259 (symptomatic removal of semilunar cartilage) at 10% was also considered.  Coding analogous to 5003 (PEB) or to 5260 (VA) were considered predominate and the Board elected coding under 5099-5260 as best aligned with the CI’s disability picture at the time of separation.  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 5099-5260.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5260 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board 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 Pain Left Knee	5099-5260	10%	
RATING	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140516, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
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 XXXXXXXXXX,  AR20160007485   (PD201402237)

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: