RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01099
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030723

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Transportation Management Coordinator, medically separated for “chronic pain, left knee…,” with a disability rating of 10%.

CI CONTENTION:  The CI requested a review of all conditions.  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 - 20030625	VARD - 20030826	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee…	5099-5003	10%	Osteochondritis Dessecans, Left Knee	5299-5260	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in May 2000 for an osteochondritis dissecans (OCD) lesion (damage to a piece of cartilage and underlying bone).  Following surgery his condition improved, but later worsened and he was referred to an MOS Medical Review Board and reclassified from Infantry to Transportation.  He later deployed, but was medically evacuated from theater due to left knee pain.  Radiographic imaging showed evidence of the old OCD lesion.

At the time of an orthopedic clinic appointment on 28 April 2003, 3 months prior to separation, the CI reported left medial knee pain with some swelling.  Physical examination showed flexion of 140 degrees (normal 140) and extension of 0 degrees (normal 0).  There was no painful motion, but tenderness was present along the medial joint line.  Examination testing for meniscal pathology was negative.  Patellar motion was normal.  The MEB NARSUM on 22 May 2003 (2 month before separation) recorded a complaint of medial left knee pain with activity.  Pain was usually 3-4 (presumably out of a maximum of 10) on the pain scale which occasionally increased to 6 or 7.  The CI reported that his left knee would occasionally swell.  Physical examination noted normal passive ROM (140 degrees flexion, 0 degrees extension) without pain; however active ROM measurements were not provided.  There was tenderness along the medial joint line.  Examination testing for meniscal pathology was negative.  He had normal patellar motion.  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 10%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the left knee condition 10%, coded 5299-5260 (analogous to limitation of leg flexion) based on the STR, citing painful motion and functional loss as a rationale.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  Although applicable, the 5259 code (cartilage, semilunar, removal of, symptomatic) does not provide a rating higher than 10%.  While a rating could be considered under the 5255 coding pathway (femur, impairment of, malunion), the “moderate knee disability” stipulation was not present, therefore the next higher 20% rating was not warranted via this code.  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel 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 panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008431, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

               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