RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04276
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041008

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Cannon Crewmember, medically separated for “right knee pain,” with a disability rating of 0%.  

CI CONTENTION:  The CI contends his overall rating was higher from the VA.  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 - 20040706	VARD – 20041201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	0%	Right Knee Meniscus Tear, Postoperative (Claimed as Pain)	5099-5024	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed right knee pain in 2002.  He ultimately required arthroscopic surgery for a meniscus tear in July 2003, but further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right knee cap pain secondary and consistent with retropatellar pain syndrome” for PEB adjudication.  The DD Form 2808, Report of Medical Examination, dated 2 March 2004 (7 months prior to separation) recorded right knee extension of 0 degrees (normal) and flexion of 110 degrees (normal 140).  All knee ligaments were stable, and a test for meniscal damage was negative.  Crepitus was present and a limping gait was noted.  
During the MEB narrative summary (NARSUM) examination dated 16 March 2004 the CI endorsed right knee pain, intermittent swelling and an inability to walk without a cane and hinged knee brace.  Physical examination revealed painful right knee motion and patellar tenderness.  Knee ligaments were intact and meniscal testing was negative.  Right knee extension was 0 degrees and flexion was 130 degrees.  There was no VA Compensation and Pension (C&P) examination in evidence proximal to separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 0% coded analogously to 5003 (degenerative arthritis), citing full range of motion without ligamentous laxity.  The VA rated the condition 10% coded 5099-5024 (analogous to tenosynovitis) for painful motion reported by the MEB examiner.  Board members agreed there was no limitation of flexion or extension that supported a rating higher than 0% under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case, and provided an alternate route to a 10% rating.  There was no evidence of subluxation or lateral instability to support a separate rating under the 5257 code (knee, other impairment) and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions to justify use of the 5258 code.  Lastly, 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).  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 right knee condition, coded 5259.

BOARD FINDINGS:  In the matter of the right knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5259 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 medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain	5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141114, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160011497, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

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
 
7/28/2016

XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretary of the Army
Siqned by: XXXXXXXXXXXXXXXXXXX