RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01744
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Signal Support Systems Specialist, medically separated for “chronic right knee pain,” with a disability rating of 0%.

CI CONTENTION:  The CI’s conditions continue to worsen and negatively affect daily activities.  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 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 - 20050426	VARD - 20051220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Right Knee Retropatellar Pain Syndrome	5260	NSC	20050719	
Recurrent Minor Back Pain	Not Unfitting	Low Back Strain	5237	0%	20050719	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY: 

Chronic Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain began in November 1996 when he fell from a tactical vehicle while deployed.  Following years of conservative treatment, arthroscopy was performed in April 2004 for a suspected tear of the medial meniscus.  However, no tear or other abnormalities were found.  X-rays of the right knee in February 2005 were normal. 

An orthopedic MEB consultant on 9 March 2005, 2 months prior to separation, recorded a complaint of difficulty getting in and out of vehicles due to right knee pain.  He could not walk more than 2 miles comfortably.  Physical examination showed excellent patellar tracking and no evidence of patellar apprehension.  Range of motion (ROM) was described as “full,” but measurements were not provided.  Testing for meniscal injury was negative.  There was no mention of painful motion.  The MEB physical examination (recorded on the DD Form 2808) on 28 March 2005 documented right knee flexion of 140 degrees (normal 140) and extension of 0 degrees (normal 0).  There were no signs of meniscal injury.  There was no mention of painful motion.  The MEB NARSUM examination on 12 April 2005, 1 month prior to separation, noted complaints of anterior right knee pain, described as chronic and "constant" with a pain level of 3-4/10.  Aggravating factors included going up and down hills and stairs, climbing in and out of vehicles, or carrying heavy loads.  He had not been able to run for 2 years, although he could walk at his own pace, which was limited to about 1.5 miles when he had to stop and rest.

At the 19 July 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported daily knee pain under the patella at a severity level of 4/10.  He could walk 2 miles, sit for 1 hour and stand for 30 minutes, but wore a brace if he anticipated prolonged activity.  He could comfortably lift 50 pounds.  Physical examination showed a normal gait and no difficulty arising from a chair or changing positions on the examination table.  No assistive devices or braces were used.  Right knee flexion was 140 degrees and extension was 0 degrees.  There was no right knee tenderness, swelling or crepitus.  Testing for meniscal injury was negative, and squats were performed “repetitively without difficulty.”  Repetitive motion “[did] not exhibit any pain, fatigue, weakness or incoordination.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain 0%, coded analogously as 5003 (arthritis, degenerative).  The VA did not service-connect the right knee pain, coded 5260 (leg, limitation of flexion of), based on the C&P examination 2 months after separation, because there was no objective evidence of chronic disability.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence 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 those codes.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  No additional functional limitation was evidenced by the examinations.  Therefore the panel concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  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 right knee pain.  

Contended PEB Condition:  Recurrent Minor Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic right knee pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended recurrent minor back pain condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are 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 20150610, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008864, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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,					      
						      					
Enclosure