RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01543
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Medic, medically separated for “chronic left knee pain, status post (S/P) meniscus repair,” with a disability rating of 10%.  

CI CONTENTION:  “Increasing incidents of left pain with intermittent locking which makes it difficult for me to maintain employment in my paramedic field; subsequent surgery in July 2006 at the VA Nashville Hospital, for complaints that were ignored after the initial surgery in Dec. 2003, that rendered me unfit and that were not documented or injured by the physician who performed my MEB physical.”  The CI’s 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 panel 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 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 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 - 20030708	VARD - 20040427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain, S/P Meniscus Repair	5099-5003	10%	Meniscal Tear S/P Surgical Repair, Left Knee	5299-5260	10%	Service Treatment Records (STR)	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain, S/P Meniscus Repair.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in October 2002 when his left knee locked-up running during a physical fitness test.  He underwent a diagnostic left knee arthroscopy with medial meniscal repair and medial plica debridement on 3 December 2002.  

Magnetic Resonance Imaging (MRI) performed in March 2003 showed a moderate joint effusion, tendinopathy in the anterior cruciate ligament, a small lateral meniscus cyst and no obvious meniscal tear.  Radiographic studies done in February 2004 showed mild bony demineralization.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left knee pain S/P meniscus repair” for PEB adjudication.  

The MEB NARSUM examination on 5 June 2003, 4 months prior to separation, noted complaints of recurrent swelling of the left knee with pain and locking at times.  The physical examination showed range of motion (ROM) of flexion 90 degrees (140 degrees normal) and extension 20 degrees (0 degrees normal), with painful motion.  There were functional limitations of an inability to run, jump, march or participate in PT tests or exercises.  

There was no VA Compensation and Pension(C&P) test performed.  At the time of a VA outpatient orthopedic appointment on 5 February 2004, 4 months after separation, the CI reported that his left knee “gave way” when he stepped off of an approximate 8-inch step and he had significant knee pain.  On examination, there was no joint line tenderness.  There was significant atrophy of the left quadriceps muscles and effusion.  Knee ROM (with distraction) was extension of 0 degrees and flexion limited to 110 degrees with pain on terminal flexion.  There was no evidence of instability and testing for meniscal pathology was equivocal, with some pain noted.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain condition 10%, coded 5099 5003 (analogous to arthritis, degenerative), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left knee condition 10% coded 5299 5260 (analogous to leg, limitation of flexion), based on the VA treatment records that showed flexion limited to 110 degrees and full extension.  

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 persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic) 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).  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 condition.  

BOARD FINDINGS:  In the matter of the left knee condition 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 20150622, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170003519, XXXXXXXXXXXXXXXXXX. 

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,