RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01641
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Reserve E5, Combat Engineer, medically separated for “left knee pain,” with a disability rating of 0%.  

CI CONTENTION:  “Please review 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 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 conditions 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 - 20040823	VARD - 20050527	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Left Knee Injury with Instability	5257	10%	20000712	
			Medial Meniscal Tear, Left Knee, Surgically Treated	5260	10%		
			Left Knee Injury with Limitation of Motion in Extension	5261	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain began in 1997 during a previous enlistment.  The CI underwent surgical repair for a torn meniscus in 1998 and was discharged in July 1998, with the VA assigning a 10% disability rating.  The CI re-entered service and re-injured the knee during a deployment to Iraq in December 2003.  Arthroscopic examination in June 2004 documented chondromalacia of the medial knee (femoral condyle and of the medial patellar facet) and multiple foreign bodies.  The post-operative course resulted in full knee range of motion (ROM).  However, pain persisted and conservative physical therapy and orthopedic treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left knee pain secondary to degenerative changes” for PEB adjudication.  At the MEB NARSUM examination on 6 July 2004 (2 months before separation), the CI reported pain aggravated by walking, running, climbing stairs, and prolonged standing.  Physical examination showed full ROM and normal strength without evidence of instability, tenderness, or effusion.  
At the MEB examination (recorded on DD Forms 2807 and 2808) dated 30 July 2004 (6 weeks before separation), the physical examination showed medial knee tenderness and “decreased” flexion.  There was no VA Compensation and Pension examination in evidence proximate to separation for review. 

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the left knee pain 0%, analogously coded 5003 (degenerative arthritis), citing full ROM, crepitus, and pain, with no evidence of instability.  The PEB determined the left knee condition existed prior to service and was permanently service aggravated.  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).  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 10% 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 recommends a disability rating of 10% for the left knee pain, coded 5010 (traumatic arthritis).  

PANEL FINDINGS:  In the matter of the left knee pain, the panel unanimously recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Left Knee Pain	5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006481, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	 
Enclosure