RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01701
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20061214

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

CI CONTENTION:  The CI contends he continues to suffer from knee pain and swelling.  The 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 - 20061003	VARD - 20080626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5009-5003	0%	No VA Examination in Evidence	
COMBINED RATING:  0%	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 underwent surgery in March 2006 to remove a benign tumor from the femur (the upper leg bone) near the left knee.  At the orthopedic clinic appointment on 24 May 2006, 7 months prior to separation, the CI reported left knee pain that limited his ability to run and climb stairs.  Physical examination showed a fully healed 20 cm scar lateral to the patella, swelling, tenderness to palpation, and full range of motion (ROM) with pain.  At a second orthopedic examination on 7 July 2006, 6 months prior to separation, ROM was recorded as flexion at 140 degrees (normal 140) with pain. Testing for cartilage damage (McMurray test) was positive as was testing for potential dislocation or subluxation (patellofemoral apprehension test).  During the 26 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported knee trouble marked by “giving out” and “sharp pain” and indicated that he used a knee brace during activity.  The examiner annotated chondromalacia (cartilage degeneration) with crepitus (grinding) and left lateral meniscus (knee cartilage) deformity in the summary of defects and diagnoses.  The 21 August 2006 MEB NARSUM (written by an orthopedic surgeon), 4 months prior to separation, noted complaints of pain about the left distal femur with prolonged standing, formations, running, jumping, or walking on even ground.  Physical examination noted no swelling, no effusion (fluid buildup in the joint), and no erythema (reddening of the skin due to capillary dilation).  ROM measurements, not limited by pain, were recorded as flexion at 130 degrees (normal 140) and extension of -5 degrees (normal 0).  There was no laxity indicated (negative varus/valgus Lachman’s, and anterior/posterior drawer testing), but there was mild tenderness.  Radiographic study showed mild osteoarthritis with no evidence of the previous tumor.  Additionally, the examiner noted the lateral meniscus tear could be addressed with surgery, but the CI declined.  There was no VA examination in evidence proximate to separation.  An MRI dated 18 December 2007, 12 months after separation, demonstrated a meniscal tear and a moderate sized joint effusion.  

The panel 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 the absence of significant loss of ROM and no instability.  There was no limitation of flexion or extension that supported a rating under those relevant VASRD diagnostic codes (5260 or 5261).  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) to support a rating under those respective codes. While there was a tear of the meniscus that was symptomatic, there was no surgical removal, so use of the 5259 code is not applicable.  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, though, evidence of painful motion with functional loss with prolonged standing, running, and jumping supporting a 10% rating based on VASRD §4.59, §4.40 and §4.45, as noted at the orthopedic examinations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the chronic left knee pain condition, analogously coded 5003.  

BOARD FINDINGS:  In the matter of the chronic left knee pain condition, the panel majority recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  The single voter for dissent recommends no change and elected not to submit a minority opinion.  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	
Chronic Left Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, w/attachments
Exhibit B.  Service Treatment Record

AR20170008719, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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