RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01390
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070717

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Military Police, medically separated for “chronic left knee pain,” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  The CI’s 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 upon a 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 - 20070426	VARD – 20070815	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Left Knee Laxity	5237	20%	20070613	
			Left Knee Patellofemoral Syndrome	5261	0%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

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 condition began in August 2005 without specific injury.  Radiographic (X-ray) studies on 24 July 2006 showed mild facet narrowing or patellar tilt without subluxation, which the examiner noted might be compatible with an excessive pressure syndrome.  There was no evidence of loose bodies, the femoral tibial joints were within normal limits, the osseous structures were intact, and there was preserved bone mineralization; however, there was fabella (sign of displacement or effusion).  Magnetic imaging studies on 10 October 2006 indicated chondromalacia patella with an associated moderate-sized joint effusion.  The remainder of the examination was within normal limits.  X-ray studies on 5 February 2007 revealed no acute osseous or articular abnormality.  The extensor mechanism was intact and there were no significant degenerative changes; a normal study of the left knee.    There was no surgical indication and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left knee chondromalacia patella” for PEB adjudication.

During the MEB NARSUM examination on 16 February 2007, 5 months prior to separation, the CI reported constant, very dull aching to throbbing pain in the anterior aspect of the left knee, with frequent sharp stabbing pain in the joint, rated 3-9/10 scale.  The pain was aggravated by running, wearing body armor or a backpack, jumping, walking long distances, negotiating stairs, and repeated squatting.  The pain was relieved by rest, ice, and moist heat.  The pain prevented him from military tasks such as patrolling (including walking patrols), conducting movement to contact, and reacting to direct and indirect weapons fire.  The CI’s pain also prevented him from participating in military training in an urban area or assisting in setting up or tearing down tactical field sites.  Physical examination showed no effusion, erythema, edema, or ecchymosis.  There was no joint line tenderness both medially and laterally.  However, there was slight tenderness to palpation on the left anterior knee along the lateral patellar border and there was positive patellar grind.  Examination tests for ligamentous instability and meniscus pathology were negative.  The range of motion (ROM) was normal. 
  
At the 13 June 2007 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported daily left knee pain around the knee cap with swelling of the peri-patellar and occasional giving way.  The pain occasionally travelled up into the thigh or down into the mid-shin.  The pain was described as sharp rated 5/10 scale.  The pain was aggravated by physical activity, negotiating stairs, prolonged sitting and running.  The pain was relieved by rest.  The pain prevented him from performing physical training and limited his driving or sitting time before having to change leg positions.  Physical examination showed normal gait and there was no edema, effusion, weakness, redness, heat, abnormal movement, guarding, or subluxation.  There was no recurrent subluxation, locking pain or crepitus.  The medial and lateral collateral ligaments stability test of the left knee was abnormal with moderate instability.  The anterior and posterior cruciate ligaments stability test was within normal limits and the medial and lateral meniscus test was within normal limits.  There was normal ROM measurements.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (arthritis, degenerative), citing no loss of ROM or evidence of knee instability.  The VA rated the left knee condition 20%, coded 5257 (knee, other impairment of:  recurrent subluxation or lateral instability) and 0% coded 5261 (leg, limitation of extension of), citing recurrent subluxation or lateral instability of the knee which was moderate and no evidence of pain with normal ROM.  

According to IAW VASRD §4.40, §4.45, and §4.59, a 10% rating is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261.)  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 mal union of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262.)  However, the VA examination proximate to separation demonstrated the presence of ligamentous instability or laxity (5257) supporting a 10% rating.   

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a separation rating of 10% for painful motion coded 5099-5003, and 10% for knee instability coded 5257, for a combined rating of 20% for the left knee condition.

BOARD FINDINGS:  In the matter of the chronic left knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a for painful motion and a disability rating of 10% for instability, coded 5257 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Knee Pain	5099-5003	10%	
Left Knee Instability	5257	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150619, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170002475 (PD201501390)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA