RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00501
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E3, Trainee, medically separated for “chronic right knee pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that his right knee condition is worsening.  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 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 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 - 20061117	VARD - 20071106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Status Post Right Knee Surgery with Pain and Scarring	5299-5259	0%	20070219	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in February 2006 for an osteochondral lesion (bone and cartilage damage) of the medial femoral condyle.  The post-operative course was unremarkable, however, he developed pain with restricted motion and crepitus in July 2006.  He underwent a second surgery in August 2006 for osteochondral lesion of his right medial femoral condyle.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right knee osteochondral defect post surgical fixation” for PEB adjudication.  

The physical therapy range of motion (ROM) evaluation in October 2006, 2 months pre-separation, showed flexion to 135 degrees (normal 140) and extension lacking 5 degrees (normal 0).  There was painful ROM, crepitus and effusion.  At an orthopedic visit in October 2006, the physical examination showed a ROM of 8 degrees of extension to 122 degrees of flexion, with effusion and tenderness about the patellar region.  At the 4 October 2006 MEB examination (recorded on DD Forms 2807 and 2808), 2 months per-separation, the CI reported swelling and pain aggravated by weight bearing and walking.  The physical examination was checked as “normal lower extremity evaluation.”  At the 18 October 2006 MEB NARSUM examination, 1 month prior to separation, the physical examination showed flexion to 125 degrees, extension lacking 5 degrees, with mild effusion and pain with patellofemoral compression.  There was no evidence of ligamentous instability.  There was pain with testing for meniscal injury, however, the examiner noted that there was “no discrete click.”  

At the 19 February 2007 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported pain with inability to squat or run, and denied incapacitating episodes.  Physical examination showed an effusion with normal flexion and extension.  There was no locking, pain, or crepitus, and repetitive motion was not limited by pain, fatigue, weakness, lack of endurance or incoordination.  There was no evidence of ligamentous instability or meniscal pathology.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 10& for the right knee condition, coded 5099-5003 (analogous to degenerative arthritis), citing “continued pain” and “some loss of motion.”  The VA rated 0% for the right knee condition, coded 5299-5259 (analogous to cartilage, semilunar, removal of, symptomatic), citing subjective pain with no objective findings of limitation of motion or other disability.  There was no limitation of motion which supported a higher rating under the diagnostic codes for limitation of flexion (5260) and no limitation of motion which supported a higher rating under the diagnostic code for limitation of extension (5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and 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 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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

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

AR20170004986, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					       
						      					
Enclosure