RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01669
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Specialist Electrical Device Repair, medically separated for “left knee pain,”  with a disability rating of 0%.

CI CONTENTION:  The CI requests review of all conditions. The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20060906	VARD - 20070307	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Loading Injury…Knee Strain	5099-5003	0%	Left Retropatellar Pain Syndrome	5024	10%	20061109	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Loading Injury…Knee Strain Diagnosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in November 2004 after he dislocated his knee in the bathtub.  X-rays in November 2004, were normal.  The knee healed and three weeks later the CI passed his physical fitness test without difficulty.  While deployed in January 2005, the CI reported left knee pain while wearing heavy gear and performing repetitive knee bends.  Locking and popping episodes with some instability were reported.  The CI was placed on a temporary profile.  After returning from the completed deployment in September 2005, the CI continued to have pain and running limitations.  Magnetic resonance imaging (MRI) in February 2006, showed disruption of some fibers of the anterior cruciate ligament (minor, ligament instability); however, parallel and intact fibers of his anterior cruciate ligaments were normal.  The posterior cruciate ligament, medial and lateral menisci and the medial and lateral collateral ligaments appeared intact and without injury.  X-rays in March 2006 were normal.  Despite treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “left knee anterior cruciate ligament laxity” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated March 2006, 10 months prior to separation, the CI reported knee pain and swelling.  Physical examination showed crepitus without joint line pain and no evidence of instability. Range of motion testing showed “full active range of motion”.

At the MEB orthopedic consultation examination on 5 April 2006, 9 months prior to separation, the CI reported no relief of the knee pain or instability.  Physical examination showed no evidence of thrusting or rotation.   Varus and valgus stress (ligament test) at 0 and 30 degrees were stable.  Examination showed IA Lachman with stable endpoint and slight anterior drawer with good endpoint were noted.  Patella tracking appeared normal.  Neurovascular and circulation were intact.  Strength was 5/5 with knee flexion, extension, ankle and great toe dorsiflexion, and plantar flexion.  
 
The MEB NARSUM examination on 25 April 2006, 9 months prior to separation, noted complaints of aching in his anterior left knee behind the patella.  Pain was reported at 5/10, worsening with running, jumping, bending, lifting more than 20 pounds, and standing/kneeling in place for more than 30 minutes.  Medications for pain included Tylenol and Naprosyn (non-narcotic anti-inflammatory).  The CI was determined not to be a surgical candidate. 

At the 9 November 2006 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported the pain was constant, localized, and rated 7/10.  Pain was elicited by physical activity and relieved by rest leaving the CI unable to run.  No pain medication was used.  Physical examination showed anterior and posterior cruciate ligaments stability test, medial and lateral collateral ligaments stability test, and medial and lateral meniscus test, all within normal limits. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (arthritis, degenerative), citing pain, slight, intermittent.  The VA rated the left knee condition 10% coded 5024 (tenosynovitis), based on the C&P examination 2 months before separation, citing painful motion.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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) 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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 condition, coded 5024.  

BOARD FINDINGS:  In the matter of the left knee condition, the Board recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board 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	5024	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150626, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006483, 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