RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00454
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060728

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

CI CONTENTION:  The CI indicates that he needs a knee replacement.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20060718	VARD - 20140429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain…	5099-5003	0%	Right Knee Chondromalacia…	5260	10%	20140428	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI fell during a training run in October 2005 and injured his right knee.  He initially participated in physical therapy and when he did not improve he underwent right knee arthroscopic surgery in March 2006 for chrondromalacia patella (inflammation of the underside of the kneecap).  

The 15 June 2006 MEB NARSUM examination, one month prior to separation, noted complaints of right knee pain with running, ascending stairs or standing for periods greater than 15 minutes. The physical examination showed range of motion (ROM) of flexion to 130 degrees (normal 140), extension to 2 degrees (normal 0), with a facial grimace during testing suggesting evidence of painful motion.  

The April 2014 VA Compensation and Pension (C&P) evaluation was not performed until almost 8 years after separation, and therefore was not probative to a rating recommendation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain at 0%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency pain policy (AR 635-40) and near normal ROM.  Though not probative, the panel noted the VA rated the right knee condition 10%, coded 5260 (leg, limitation of flexion of), citing a ROM of 135 degrees and no evidence of instability.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) or history of surgery to remove a meniscus (5259) to support a rating under these respective codes.  There was no fracture, nonunion, 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 minimum compensable rating of 10% (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 panel recommends a disability rating of 10% for the right knee pain, analogously coded 5099-5003.  

BOARD FINDINGS:  In the matter of the right knee pain, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.  The panel 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	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005970, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX:

	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