RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01179
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040501

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

CI CONTENTION:  The CI requests that all conditions be considered.  His 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 - 20040223	VARD - 20070319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5099-5003	10%	Avulsion Fracture…Left Knee	5299-5010	0%	20070205	
COMBINED RATING:  10%	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 underwent left knee surgery in December 1999 for a torn medial meniscus, plica syndrome, and chondromalacia.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left anterior knee pain” for PEB adjudication.  

The 23 December 2003 MEB NARSUM, 4 months prior to separation, noted complaints of persistent left knee pain and swelling.  Physical examination noted decreased bulk and tone of the muscle that runs along the inside of the thigh and serves to extend the knee (vastus medialis), along with positive testing for pathology of patellar pain (grind test).  Tests for ligamentous instability were negative (Lachman’s, varus and valgus stress tests), and there was no tenderness of the knee.  Range of motion (ROM) was recorded as “approximately” 1-135 degrees (normal 0-140), and there was no swelling or fluid buildup in the knee.  

During the 12 January 2004 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation, the CI reported impaired use of his left leg, with pain and swelling in his left knee.  Physical examination showed “full ROM” and no deformity or swelling of the knee.  

The VA Compensation and Pension (C&P) evaluation was performed almost 3 years after separation, so it was not probative to the severity of the knee condition at separation, though the examiner concluded that it was an essentially normal examination of the left knee with no painful motion, instability, laxity, or X-ray evidence of arthritis.  

The Board 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 (AR 635-40).  The VA rated the left knee 0%, coded analogously to 5010 (arthritis, due to trauma, substantiated by X-ray findings), citing a lack of X-ray evidence of arthritis and a lack of evidence of painful motion at the time of the C&P examination.  The rating was based upon the VA C&P examination 34 months after separation.  The VA additionally did not rate the left knee surgical scars.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  Alternatively, the persistence of pain after meniscal surgery would warrant a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic), but that rating includes painful motion and any coding change would provide no benefit to the CI.  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), 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.  

The Board does not recommend disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  The knee scars did not interfere with wear of military gear and were not painful at the MEB examination.  Any contribution from the scars on ROM limitation was addressed above.  There was insufficient evidence of duty-limiting impairment from the knee scars, thus the Board concluded that the scars condition could not be recommended for additional disability rating.  

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 chronic left knee pain.  

BOARD FINDINGS:  In the matter of the chronic left knee pain 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 20150610, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

09 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001470 (PD201501179)

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