RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00664
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071022

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

CI CONTENTION:  The CI requests all conditions be considered.  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 upon a 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 - 20070913	VARD - 20080205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Ganglion Cyst, Left Knee	5260	0%	20071207	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first sought medical care for his left knee condition in September 2006, without specific injury.  Radiographic studies showed a small cyst along the posterior cruciate ligament (PCL) as well as early joint space narrowing.  There was no surgical indication.  At the time of the orthopedic clinic appointment on 10 April 2007, the CI reported pain with running, jumping and squatting.  On examination the CI was noted to have crepitus, but no effusion or joint line tenderness.  His knee flexion and extension were normal and tests for instability were negative.  Despite treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left knee pain” for PEB adjudication.
The range of motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below. 

Left Knee ROM
(Degrees)	MEB ~3 Mo. Pre-Sep
	NARSUM ~3 Mo. Pre-Sep
	VA C&P ~2 Mo. Post-Sep
	
Flexion (140 Normal)	Full ROM	150	130	
Extension (0 Normal)		0	0	
Comment	Painful motion, tenderness and crepitus	Crepitus 	Crepitus	
§4.71a Rating	10%	0%	0%	

During the MEB examination (recorded on DD Forms 2807 and 2808) dated 17 July 2007, 3 months prior to separation, the CI reported left knee pain with squatting, jumping, running, and carrying weight.  He also reported his left knee was swollen.  Physical examination showed left knee tenderness to palpation and crepitus.  Although he had full ROM, he experienced pain with flexion.  The MEB NARSUM on 2 August 2007, 3 months prior to separation, noted increased left knee pain with impact activities such as running, jumping, or squatting.  The NARSUM examination noted mild crepitus, but no effusion, tenderness, or instability of the left knee.  The CI’s ROM was not limited and there was no report of painful motion.  

At the 7 December 2007 Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported left knee pain with squatting or prolonged inactivity.  Physical examination showed that his left knee ROM was limited as indicated in the chart above.  He had crepitus, but there was no evidence of painful motion.  There was no additional limitation of motion with repetitive use.  His left knee was stable and he had a normal gait. 

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 degenerative arthritis). The VA also rated the left knee condition 0%, coded 5260, (limitation of flexion), citing a higher evaluation of 10% was not warranted unless flexion was limited to 45 degrees.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) at the NARSUM or VA exam.  There likewise was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 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).  No additional functional limitation was evidenced by the examinations.  Therefore the Board concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  After due deliberation, and 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 left knee condition.

BOARD FINDINGS:  In the matter of the left 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 20150602, 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 XXXXXXXXXXXXXXXXXXXX, AR20160014891 (PD201500664)

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,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

					         
Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA