RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01349
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic left knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CIs conditions continue to worsen and negatively affect daily activities.  The 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 - 20070118	VARD - 20071003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Chondromalacia Patella, Left Knee	5260	0%	20070818	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain began in May 2004 during pre- deployment exercises at the National Training Center (NTC).  There was no surgical indication, and conservative orthopedic and physical therapy treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chondromalacia patella” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 5 September 2006, 6 months prior to separation, the CI reported constant left knee pain at “both rest and active.”  Physical examination showed the CI had a normal gait with no laxity or effusion of the left knee.  
The MEB NARSUM examination on 11 September 2006, 6 months prior to separation, noted complaints of achy and dull left knee pain that increased in intensity when “walking for 5 minutes, standing for 10 minutes, sitting all the time, running immediately, climbing, bending, squatting, and lifting.”  The left knee condition prohibited the CI from performing soldiering activities to include running, jumping, sit-ups, push-ups, 3 to 5 second rushes, digging a fighting position, and running with a fighting load of 48 pounds.  Physical examination reported ranges of motion (ROM) performed by Orthopedics with a goniometer as flexion to 100 degrees (normal 140) with pain at 85 degrees, and extension to 5 degrees (normal 0).  X-rays in April 2006 were normal and a magnetic resonance imaging (MRI) study in July 2006 showed chondromalacia patella.  

At the 18 August 2007 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported a daily pain level of 3/10 and noted the left knee did not “bother him as much as it did while he was on active duty.”  The CI additionally reported he had missed no days of work because of the condition.  Physical examination showed left knee ROM flexion to 130 degrees (normal 140) and extension to 0 degrees (normal 0) with no pain, instability, fatigue, or weakness on repetition.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain 10%, analogously coded 5003 (Arthritis, degenerative (hypertrophic or osteoarthritis)), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left knee pain 0% coded 5260 (Leg, limitation of flexion of), based on the VA C&P examination 5 months after separation, citing the records showed “essentially normal, painless motion of the left knee with no evidence of significant functional impairment.”

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.  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.
 
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 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 20150612, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005995, 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,