RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01757
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Food Service Specialist, medically separated for “right knee pain,” with a disability rating of 0%.

CI CONTENTION:  The CI contends his right knee condition has continued to worsen.  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 - 20050217	VARD – None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain…	5099-5003	0%	VA Examination not in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  Unknown	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in February 2001 while playing basketball while on active duty as a Marine.  He underwent surgery in June 2001 for an ACL reconstruction, medial meniscus repair and partial lateral meniscectomy.  In December 2001 he was cleared to enlist in the Army with full disclosure of his knee condition.  In January 2003, the CI re-injured his right knee while participating in physical training.  The CI underwent an arthroscopic medial meniscal debridement in June 2003.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right knee pain status post anterior cruciate ligament reconstruction and medial meniscal tear debridement” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated December 2004, 5 months prior to separation, the CI reported a painful right knee with difficulty standing for long periods of time and kneeling.  Physical examination showed decreased range of motion (ROM) with pain and a surgical scar over the patella.  The MEB NARSUM examination on 21 January 2005, 3 months prior to separation, noted complaints of catching with discomfort located in the medial joint line.  The CI denied locking, giving way or swelling, but was unable to run or jump.  He was able to walk wearing an ACL brace.  Physical examination showed no deformity, effusion or warmth.  The CI was tender to palpation over the medial joint line and the medial collateral ligament.  Motor and sensory were intact.  McMurray’s, anterior drawer pivot shift, Lachman, patellar grind and dial-in tests were negative.  There was no varus/valgus instability, however there was pain over the medial collateral ligament with valgus stress.  ROM was recorded as 130 degrees flexion (normal 140) and 0 degrees extension (0 normal).  A 10 February 2005 NARSUM addendum submitted ROM measurements of right knee flexion 75 degrees and extension -10 degrees (reflects inability to fully extend the right knee) noting moderate pain and guarding.  There was no VA Compensation and Pension (C&P) examination related to the CI’s second active duty period of service.  The only C&P evaluation in evidence was performed September 2001, prior to his re-accession to active duty in January 2002.  This evaluation has no probative value for rating purposes at the time of his 2005 separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (arthritis, degenerative), citing full range of motion and without ligamentous laxity and application of the US Army Physical Disability Agency pain policy.  There is no record of the VA rating the right knee condition is association with the CI’s second period of active duty.  There were no other VA examinations in evidence.  The MEB NARSUM addendum stated the right knee extension was limited to -10 degrees following repetitive motion.  This degree of limited extension supports a 10% rating for “extension limited to 10 degrees” (code 5261).  There was no limitation of flexion that supported a minimum rating under the VASRD diagnostic code for limitation of flexion (5260).  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).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  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).  The Board does not recommend disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  The knee scar did not interfere with wear of military gear and was not painful at the MEB examination.  There was insufficient evidence of duty-limiting impairment from the knee scar, thus the Board concluded that the scar condition could not be recommended for additional disability rating.  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 right knee condition, coded 5261.  

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5261 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	
Right Knee Pain	5261	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150614, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005130, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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