RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01632
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Signals Intelligence Analyst, medically separated for “chronic left knee pain” rated 10%.

CI CONTENTION:  The CI contends that his knee injury continues to negatively affect his life.  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 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 - 20090109	VARD – No Rating	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5099-5003	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in July 2008 when he dislocated the knee while doing sprints.  X-rays dated 14 July 2008 demonstrated a medial patellar fracture (kneecap) fracture with a joint effusion (fluid buildup) and significant medial soft tissue swelling surrounding the knee,  while on 23 July 2008 X-rays showed a stable appearance of the avulsion fracture in the medial left patella.  Magnetic resonance imaging (MRI) on 30 July 2008 revealed status post a prior patellar dislocation with interval reduction and a large retropatellar (below the kneecap) effusion along with a severe tearing of the medial retinaculum (connective tissue band) with strain of the medial collateral ligament.  At an orthopedic clinic appointment on 10 September 2008, 5 months before separation, the examiner noted the CI had been treated with a knee brace and physical therapy.  The CI reported left knee pain of 2/10 (10 being the worst pain).  On examination, the CI was noted to had a mildly antalgic gait with the knee brace off.  Testing for ligamentous instability was negative; there was tenderness on the medial (towards the center of the body) portion of the kneecap; and the ROM was reported as approximately 0-95 degrees, with pain around the patella on the medial side.  When the CI’s knee was fully extended and quadriceps was relaxed, the patella translated laterally about two quadrants, which caused pain medially.  Treatment consisted of a patellar stabilizing brace with a buttress and additional convalescent leave.  On 20 October 2008, the physical therapy examiner noted complaints of left knee pain rated 3/10.  ROM was measured with a goniometer at 0-100 degrees, with painful motion noted to begin at 75 degrees on flexion.  There was no additional limitation of motion after repetition.  

There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic left knee pain, status post patellar dislocation” for PEB adjudication.

During the 21 October 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), less than 4 months prior to separation, the CI reported use of a knee brace for a left knee dislocation on 15 June 2008.  The examiner checked normal for the lower extremities in the clinical examination and noted patellar subluxation in the summary of defects and diagnoses.

The 1 December 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of intermittent left knee pain caused by prolonged standing, walking, or climbing stairs.  This knee pain prevented the CI from running and when exacerbated the knee pain increased to 5/10 in severity.   No medication was taken at the time of the NARSUM examination.  Physical examination noted a mild, fluid effusion and tenderness of the left knee.  Testing for ligamentous instability was negative.  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 left knee pain 10%, coded 5099-5003 (arthritis, degenerative), citing satisfactory evidence of painful motion.  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), although the CI did have almost two quadrants of lateral patellar motion on full extension with the quadriceps relaxed. There was no history of a 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 malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  Therefore, there was 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic left knee pain.  

BOARD FINDINGS:  In the matter of the chronic left knee pain 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 20150502, w/atchs
Exhibit B.  Service Treatment Record

	

AR20170008726, 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,