RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00762
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Telecommunications Operator, medically separated for “chronic left knee pain,” with a disability rating of 0%.

CI CONTENTION:  Her military documents burnt, therefore, she is not sure of her disability rating and she requests a review of all conditions.  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 - 20040916	VARD - 20050215	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Left Knee Patellofemoral Syndrome	5260	NSC	20040510	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic 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 November 2003 after road marching during basic training.  She twisted the knee in November 2003, was evaluated in the emergency room and swelling was noted.  Diagnostic imaging (X-ray) studies 17 November 2003 showed no evidence of fracture dislocation or other significant osseous abnormality.  There was no joint space narrowing or other significant abnormality.  Diagnostic imaging (MRI) 28 April 2004 revealed a normal knee with no arthritis or structural abnormalities.  She had to do alternate fitness test and was unable to run and could not stand in formation.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left knee pain” for PEB adjudication.  

During the MEB NARSUM examination dated 10 August 2004, 3 months prior to separation, the CI reported chronic left knee pain.  The pain was relieved by medication (Motrin and Naprosyn).  Physical examination showed normal gait and strength.  Anterior and posterior drawer tests were negative.  There was no varus or valgus instability and a McMurray test was negative.  There was slight tenderness with patellar compression, however, there was no medial or lateral joint line tenderness or joint effusion.  The ROM was mildly limited in flexion.  The commander indicated the CI could not perform the duties of her military specialty due to her condition.  He stated “the CI is a good soldier but her condition creates a burden for others in her section and adversely impacts readiness.”  

At the 10 May 2004 VA Compensation and Pension (C&P) evaluation performed 5 months before separation, the CI reported left knee pain.  Physical examination showed normal gait with no tenderness to palpation in the medial and lateral joint line.  There was no varus or valgus laxity and McMurray’s and drawer tests were negative.  The ROM was mildly limited in flexion without pain.  She did not appear for the 21 October 2004 C&P examination, 2 weeks prior to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (arthritis, degenerative [hypertrophic or osteoarthritis]), rated as slight/intermittent, citing the US Army Physical Disability Agency pain policy.  The VA rated the left knee condition not service connected, coded 5260 (leg, limitation of flexion of), citing no permanent or chronic disability subject to service connection was shown by the service medical records or demonstrated by evidence following service, therefore, service connection for left patellofemoral syndrome was denied.  The MEB examination was most probative at 3 months pre-separation.  The Board noted the presence of a L3 permanent profile, slight tenderness and slightly limited ROM, as well as the use of over the counter medications.  

As noted above, the PEB used the pain policy, citing slight/intermittent pain. There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 majority concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic left knee pain condition.  

BOARD FINDINGS:  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the Board majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification and did not elect to submit a minority opinion.  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

SAMR-RB						

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 
XXXXXXXXXXXXXXXXXX, AR20170000084 (PD201500762)

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