RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00912
BRANCH OF SERVICE:  Army	SEPARATION DATE: 20050510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, X-ray Technician, medically separated for “left knee pain” with a disability rating of 0%.

CI CONTENTION:  “Both needs pop out of place from time to time.”  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 - 2050311	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain…diagnosed  Patella Instability…History of Patella Dislocation	5257	0%	No VA Exam in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Knee.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee was injured in 1999 resulting in medial collateral ligament and posterior cruciate ligament tears.  In September 2003, the CI experienced a patella dislocation.  The 27 October 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of patella instability while running or prolonged walking.  Physical examination showed McMurray (meniscus tear), Lachman (anterior cruciate ligament stability) and patella compression testing were negative.  Varus and Valgus (ligament stability) testing was stable.  There was increased lateral patellar mobility (instability) and patellar crepitus present.  The active range of motion was left knee flexion 120 degrees (normal 140) and extension 0 degrees (normal 0) but painful range of motion and gait were not addressed.  The examiner diagnosed left patellar instability with the CI unable to run or perform the aerobic fitness testing. 

There was no VA examination in evidence within the 12-month allowable window for adjudication.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5257 (knee, other impairment), citing full range of motion without evidence of ligamentous laxity.  The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, the examination proximate to separation did demonstrate the presence of patellar lateral instability with evidence of recurrent mild effusion and non-compensable limitation of motion (5257).  The panel agreed there was sufficient evidence of functional impairment secondary to patellar instability with non-compensable limitation of motion and swelling for a 10% rating for slight knee impairment under 5257 (based on §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 left knee condition, coded 5299-5257.

BOARD FINDINGS:  In the matter of the left knee condition, the panel, unanimously recommends a disability rating of 10%, coded 5299-5257 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	
Left Knee Pain 	5299-5257	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150607, w/atchs
Exhibit B.  Service Treatment Record

Dear XXXXXXXXXXXXXXXXXXXXX:

	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