RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01622
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050904

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E3, Armor Crewman, medically separated for “chronic right knee pain” with a disability rating of 10%.

CI CONTENTION:  The CI requests the Board consider all conditions.  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 - 20050729	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	No VA examination in evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced an onset of right knee pain in October 2004 (11 months before separation) while running.  Magnetic resonance imaging (MRI) demonstrated an incidental ganglion cyst, but was otherwise normal and all menisci and ligaments were intact.  There was no outpatient STR clinical evidence probative to rating.  Surgery was not indicated; conservative treatment did not result in sufficient improvement to allow unrestricted duty.  The MEB forwarded “internal derangement of the right knee” for PEB adjudication.    

The NARSUM examination on 27 April 2005 (4 months before separation) documented improvement but continued pain rated 4/10 “aggravated by running, prolonged walking, and squatting.”  There was no mention of subjective instability, recurrent effusions, or locking; and, the CI had been able to return to his civilian job as a dock worker.  The physical examination recorded a slight antalgic gait, mild tenderness, and stability to anterior and posterior stress testing.  The NARSUM referenced formal range of motion measurements for the MEB by physical therapy that documented flexion of 118 degrees (normal 140, 45 for minimum 10%) and extension of minus 2 degrees (normal 0, minus 10 degrees for minimum 10%), specifying painful motion.  There was no VA examination in evidence, the CI has not submitted a VA claim proximate to separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating referenced the US Army Physical Disability Agency (USAPDA) pain policy (AR 635-40), and was consistent with VASRD §4.71a criteria for the service evidence.  There was no minimum compensable ROM limitation.  There was no evidence (corroborated by imaging) for instability, locking with persistent effusion, or fracture with non-union or malunion.  There was thus no supported criterion that would justify a rating higher than 10% under any applicable §4.71a code, and no grounds for separate rating 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 right knee condition.  

BOARD FINDINGS:  In the matter of the chronic pain, right 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, with attachments
Exhibit B.  Service Treatment Record

AR20170003536, 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,