RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01841
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030220

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

CI CONTENTION:  “Disability rating should be increased due to service related injuries.”  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 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 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 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 panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20030108	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5010	0%	No VA Examination in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a left knee injury on 13 July 2001 during an airborne operation.  On 11 October 2001, the CI underwent left knee diagnostic arthroscopy and lateral collateral ligament (LCL), and posterolateral corner, reconstruction with a tibialis posterior tendon graft.  

At the time of the 10 May 2002 orthopedic surgery appointment, left knee examination revealed patellofemoral pain.  There was no joint line tenderness or effusion (fluid collection).  Left knee active range of motion (ROM) was flexion of 145 degrees (normal 140) and a normal extension of 0 degrees.  There was no lateral instability and the Lachman (assesses anterior cruciate ligament [ACL]) and prone external rotation (assesses LCL, posterior collateral ligament [PCL], and posterolateral corner) tests were negative.  

During the 30 September 2002 MEB examination (recorded on DD Forms 2807 and 2808), 5 months before separation, the CI reported numbness and tingling in his left knee.  The examiner noted that the CI was wearing a Donjoy brace on his left knee and laxity was not assessed due to pain.  The left knee examination revealed surgical scar and joint line tenderness.  

At the 21 October 2002 MEB NARSUM, 4 months before separation, noted that the CI was unable to wear load bearing equipment, or walk over uneven terrain, due to left knee pain.  The left knee examination revealed scars.  There was medial scar and lateral joint line tenderness.  “Patient was wearing a Donjoy brace.  Laxity was unable to be assessed due to patient's pain.  He had no McMurray's [assesses menisci], no anterior or posterior drawer [assesses ACL and posterior cruciate ligament (PCL)].”  

At the time of the 22 November 2002 physical therapy (PT) appointment for MEB ROM measurements, left knee showed a flexion of 130 degrees and a normal extension of 0 degrees.  The 10 December 2002 MEB addendum left knee examination documented pain-free ROM with a flexion of 130 degrees and extension of 0 degrees.  The Lachman’s test was negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5010 (post-traumatic arthritis), citing “full ROM without pain” and “no evidence of ligamentous laxity.”  There was no VA Compensation and Pension examination, or VA Rating Decision (VARD), in evidence.  

There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 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).  No additional functional limitation was evidenced by the examinations.  The panel majority agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, coded 5010.  

BOARD FINDINGS:  In the matter of the left knee pain condition, the panel majority recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a.  The single voter for dissent recommended no change and did not elect 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	
Left Knee Pain	5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150706, w/attachments
Exhibit B.  Service Treatment Record

AR20170009174, 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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,	
Enclosure