RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03550
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Infantryman, medically separated for “left knee pain” with a disability rating of 0%.

CI CONTENTION:  His condition continues to worsen and negatively impacts his daily activities.  Additionally, he was not evaluated for his PTSD condition.  The CI’s 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 - 20040930	VARD - 20050702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Patellofemoral Syndrome, Left Knee	5299-5020	10%	20050415	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Left Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in October 2002 while running.  Magnetic resonance imaging on 29 August 2003 confirmed no meniscal (semilunar cartilage) tear, but degenerative changes of the patella were noted.  At the time of the orthopedic clinic appointment on 3 October 2003, the CI reported knee pain that did not improve with profiles or nonsteroidal anti-inflammatory drugs.  On examination, tenderness over the medial condyle with palpable plica (joint soft tissue which becomes enlarged/inflamed) was noted.  No ligament instability or effusion was present.  An injection was administered with complete relief.  The CI deployed, but was returned to CONUS in April 2004 due to pain and swelling that was limiting his ability to perform his military specialty.  Radiographic studies on 16 April 2004 noted minimal degenerative joint disease.

At the orthopedic appointment on 4 May 2004, the CI reported an arthroscopic debridement in 2000 with a “loose body” excision while serving in the Marine Corps.  The CI had been recently evacuated from theater due to knee pain.  His left knee pain was unresponsive to therapy, activity modifications and injections.  On examination there was no effusion, joint line tenderness or ligamentous instability.  Strength was normal and range of motion (ROM) was extension 0 degrees (normal 0) and flexion 135 degrees (normal 140).  At the MEB examination (recorded on DD Form 2807 and 2808) dated June 2004, 5 months prior to separation, the CI reported left knee pain with swelling, numbness and locking sensation.  Physical exam showed no crepitus and tests for ligamentous instability and meniscus pathology were negative.  At the MEB NARSUM exam, the CI reported his knee ached all the time, rated 7/10, but when aggravated the pain became sharper with some numbness and the pain advanced to 10/10.  The MEB examiner referred to the DD 2808 exam and ROM from the May orthopedic examination was cited.

At the VA Compensation and Pension (C&P) examination in April 2005, performed 4 months after separation, the CI reported constant knee pain at the medial joint line area.  The CI reported pain with extended walking, driving, going up and down stairs, standing or sitting. He was not able to run.  Physical exam showed a slight antalgic gait.  He could squat to 45 degrees and toe and heel walking aggravated his pain.  On examination the left knee ROM was extension 0 degrees and flexion 108 degrees with pain.  After repetitive motion it was difficult to get an exact measurement, but for a brief period he was unable to flex beyond 100 degrees and extension was just shy of 20 degrees.  There was no instability and Lachman and anterior drawer tests were negative.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5099-5003 code (arthritis, degenerative), citing no loss of motion and normal radiographs.  The VA assigned a 10% rating using an analogous 5299-5020 code (synovitis) based on the VA C&P examination 4 months after separation, citing limitation and painful ROM with no instability.  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 coded either as 5099-5003 for limited motion of a single major joint with imaging evidence of degenerative arthritis or coded analogously with a ROM code (based on §4.59 (painful motion), §4.40 (functional loss) and §4.45 (joints)).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior to medical separation:

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140723, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160008182, 

Dear 

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.   I have reviewed the Board's recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical
Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

Enclosure