RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01269
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E2, Trainee, medically separated for “left knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI indicates his “condition has gotten worse.”  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 - 20090318	VARD - 20090730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	Left Knee Condition	5299-5260	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  No Rating	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began as early as 2002 when, at age 12, he underwent left knee arthroscopic surgery for a torn meniscus.  The records for this are not available.  The history of a knee injury and surgery was not disclosed at accession.  The knee pain gradually resurfaced in Advanced Individual Training in 2008.  The CI denied specific trauma.  X-rays showed a questionable bony defect on the back of the outer half of the knee (osteochondral defect on the posterior horn of the lateral femoral condyle).  An MRI on 24 November 2008 also noted a posterior horn lateral meniscal tear.  The medial meniscus (an internal cartilage cushion) and internal ligaments were intact.  In orthopedics on 5 January 2009, almost 3 months prior to separation, he was noted to have a stable knee and normal gait with normal range of motion (ROM) compared to the uninjured side.  Surgery was discussed, but the CI declined and elected to proceed with an MEB.  The left knee condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and the CI was referred for an MEB.  The MEB forwarded “left knee osteochondral defect…” for PEB adjudication.  The ROM in physical therapy on 11 February 2009 showed painful motion on the left with active flexion limited to 125 degrees.  Extension was (-) 10 degrees.  The unaffected right knee showed normal pain-free motion from 0-140 degrees.  The CI did not report for a scheduled VA Compensation & Pension examination.  

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 limitation of motion by pain.  The VA determined the left knee condition was not service connected, citing evidence that the knee condition existed prior to service and the lack of evidence of service aggravation.  There was no limitation of motion which supported a 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) to support a rating under those respective codes.  The MRI did show a torn lateral meniscus supporting a 10% rating under 5299-5259 (analogous to symptomatic meniscus after surgery).  This incorporates 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.  It provides no rating advantage to the CI though.  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.  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 left knee pain.  

BOARD FINDINGS:  In the matter of the left knee pain 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 20150615, w/atchs
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, AR20170001273 (PD201501269)

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