RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01346
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090327

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

CI CONTENTION:  The CI made no specific contention.  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 - 20081220	VARD - 20150324	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	Right Knee S/P Arthroscopic Surgery-Meniscal Repair	5260	10%	20150302	
			Multiple Scars to Right Knee	7801	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain began in 2006 in the absence of any trauma.  Despite physical therapy and medication (naproxen, a nonsteroidal anti-inflammatory drug (NSAID) and tramadol (an opioid-like medication) pain persisted.  The CI underwent right knee surgery in September 2007 where the suprapatellar plica (a fold of the synovial membrane) and the small medial parapatellar (around the kneecap) plica were excised and a lateral retinaculum release was performed.  Following surgery, extensive physical therapy was carried out, but further treatment including Darvocet (propoxyphene, a narcotic and acetaminophen, a pain reliever) and celecoxib (an NSAID) did not result in improvement sufficient to allow unrestricted duty.  X-rays in May 2008 demonstrated no evidence of acute bony abnormality, effusion, soft tissue swelling, fracture or dislocation.  

During the MEB examination (recorded on DD Forms 2807-1 and 2808) dated 11 June 2008, 9 months prior to separation, the CI reported right knee surgery to remove a plica and a lateral release.   Physical examination showed no medial or lateral instability, a swollen appearance due to probable synovial thickening, tenderness to palpation to the infrapatellar tendon and medial and lateral patellar borders and increased pain with repetitive range of motion (ROM).  At a physical therapy appointment on 15 July 2008, ROM measurements were performed revealing flexion of 145 degrees (normal 140) and extension of 0 degrees (normal 0).  The examination showed the CI experienced painful motion during ROM testing.  

At the time of the primary care clinic appointment on 25 August 2008, the CI reported constant knee pain that was aggravated with movement.  Additionally, the CI experienced swelling following surgery.  The CI noted no instances of catching, locking or giving out.  On examination the knee showed no tenderness or laxity.  The ROM was full with some swelling noted.  At an orthopedics evaluation on 9 September 2008 the examiner noted the CI had a postoperative hemarthrosis (blood in the joint), which was aspirated and the CI subsequently regained his full ROM.  However, continued knee pain persisted.  On examination he was 3-5 degrees shy of full extension and had near full flexion.  There was no laxity and he had tenderness to palpation slightly along the lateral peripatellar retinaculum and some mild quadriceps atrophy on the right compared to the left.  The examiner opined the CI’s complaint of retropatellar pain combined with mild quadriceps atrophy indicated his leg was not fully rehabilitated and he needed to continue strengthening exercises.  The 7 October 2008 MEB NARSUM, 5 months prior to separation, noted a complaint of constant pain, which was aggravated by movement.  The CI also had flares that lasted 5-6 hours requiring assistance with ambulation.  Walking long distances or climbing stairs exacerbated the pain.  On examination, the CI could flex the right knee to 135 degrees with a decrease to 130 degrees after the third repetition due to pain.  There was no mention of an extension measurement.   

There was no VA examination proximate to separation.  A VA Compensation and Pension (C&P) document was available to the panel from 2015, 6 years after separation, which provided no probative value.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing painful motion.  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 as adjudicated by the PEB.  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).  Therefore, there was 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 right knee condition.

BOARD FINDINGS:  In the matter of the right 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007465, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	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