RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01532
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Light-Wheel Vehicle Mechanic, medically separated for “bilateral knee pain from osteochondritis dissecans,” with a disability rating of 20%.

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 - 20080903	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain from Osteochondritis Dissecans	5099-5003	10%	No VA Exam in Evidence	
		10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bilateral Knee Pain from Osteochondritis Dissecans:

Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain condition began in November 2005 while performing a physical fitness test.  Arthroscopic surgery was performed in January 2007 for an osteochondral defect (OCD, damage to a piece of cartilage and underlying bone) of the medial femoral condyle.  Recurring pain led to removal of surgical screws in May 2007.

At an orthopedic examination on 22 February 2008, 10 months prior to separation, right knee flexion was noted to be 135 degrees (normal 140) and extension 0 degrees (normal 0).  During an examination by physical therapy (PT) on 21 April 2008, 8 months prior to separation, the CI displayed a gait that was not functionally limited.  He could squat without pain.

During the NARSUM examination dated 20 August 2008, 4 months prior to separation, the CI reported that right knee pain was improved compared to 6 months previously, but it still caused problems during running, prolonged walking or climbing stairs.  However, he could “walk 2-3 miles without needing to stop secondary to pain.”  The pain was relieved by hot showers and rubbing his knees.  Physical examination showed right knee flexion of 125 degrees and extension of -5 degrees.  The examination was silent regarding painful motion, although pain was reported “with manipulation.”  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (arthritis, degenerative), citing “slight mechanical loss of flexion” as a rationale.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261), although the persistence of pain after meniscal (cartilage) surgery supported a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  Because the OCD lesion involved the femoral condyle aspect of the knee, a rating was also considered under an analogous 5255 code (femur, impairment of; malunion).  However, “moderate” knee disability was not described by the objective evidence at hand, therefore a 20% rating was not warranted.  There was therefore 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 pain condition.

Left Knee Pain.  According to the STR and MEB NARSUM, the CI’s left knee condition began in June 2007 while being treated for right knee pain.  The CI denied any injury.  Evaluation revealed an OCD lesion of the medial femoral condyle which was treated surgically in December 2007.  During an evaluation by PT on 21 April 2008, 8 months prior to separation, the CI reported minimal pain medial to the kneecap during impact activities.  Examination displayed a gait that was not functionally limited.  He could squat without pain and could hop normally on his left leg with a complaint of minimal left knee pain.

At an orthopedic evaluation on 17 July 2008, 5 months prior to separation, the CI reported persistent lateral knee pain that prevented running, jumping or jogging.  Physical examination showed left knee tenderness.  A sign of possible meniscal injury was negative.  Left knee flexion was 130 degrees and extension 0 degrees.  At the NARSUM examination 4 months prior to separation the CI reported that he avoided activities such as a lot of walking or climbing stairs due to left knee pain.  However, he could “walk 2-3 miles without needing to stop secondary to pain.”  Physical examination showed left knee flexion of 125 degrees and extension of -5 degrees.  The examination was silent regarding painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003, citing “slight mechanical loss of flexion” as a rationale.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  Although an analogous 5255 code was applicable, a 20% rating for “moderate” knee disability was not supported.  There was therefore 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 left knee pain condition.

BOARD FINDINGS:  In the matter of the right knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the left knee pain 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150621, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008577, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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