RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01844
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030116

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

CI CONTENTION:  “Review 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 - 20021104	VARD - 20030313	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Residuals, Right Knee Injury	5299-5260	0%	20030220	
Mild Right Shoulder Impingement	Not Unfitting	Rotator Cuff Tendonitis, Right Shoulder	5099-5021	0%	20030220	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had right knee surgery in May 1998 for meniscal tear (MT).  There were mild degenerative changes of the patella cartilage noted at the time of that surgery.  The CI re-injured the knee in December 1999 when he fell in a hole during a field maneuver and underwent right knee surgery in February 2001 for reconstruction of the anterior and posterior cruciate ligaments.  At serial orthopedic exams after the surgery, the right knee was noted to be stable and have range of motion (ROM) with extension of 0 degrees (normal 0) and flexion of 120 to 135 degrees (normal 140).  The CI reported recurrent symptoms after a fall on the knee in June 2001 and orthopedic exams noted findings consistent with patellofemoral symptoms.  Physical therapy suggested the CI may have a medial MT and magnetic resonance imaging showed a possible MT.  At the orthopedic evaluation on 5 April 2002, 9 months before separation, the examination showed patellar crepitus, positive patellar grind, negative laxity, and a ROM of extension of 0 degrees (normal 0) and a flexion of 130 degrees (normal 140).  Arthroscopic surgery for the patellofemoral symptoms was scheduled, but the CI decided against further surgery.  The MEB forwarded “chronic right knee pain” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 16 July 2002, 5 months prior to separation, the CI reported right knee pain aggravated by stairs, walking uphill, or prolonged standing.  He reported locking of the knee.  He reported use of a knee brace when walking on uneven ground.  The physical exam noted decreased ROM of the right knee without effusion, with three arthroscopic surgery scars.  At the MEB NARSUM, 27 September 2002, 4 months before separation, the CI reported chronic right knee pain with swelling.  He denied any instability or locking.  The physical exam noted “full ROM” of the lower extremities.  There was mild swelling of the right knee.  There was no evidence of instability or meniscal injury.  There was no tenderness to palpation of the patellar tendons and patellar grind test was negative.   

At the 20 February 2003 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported no knee pain and that sometimes he could go days without pain depending on activities.  Aggravating activities included stairs or walking on an incline.  He reported flare-ups three to four times per week that lasted variable amounts of time.  He denied swelling, heat, redness or instability, but noted some occasional weakness and infrequent locking or catching.  Physical examination showed tenderness over the medial joint and minimal weakness, without guarding of movement or effusion.  Knee ROM was extension 0 degrees and flexion of 125 degrees with no pain on motion.  There was no crepitus and patellar compression was negative.  There was no evidence of significant instability or meniscal symptoms.  Right knee X-rays noted only surgical changes with intact surgical screws.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing full active range of motion with no evidence of joint instability.  The VA rated the right knee condition 0%, analogously coded 5299-5260 (leg, limitation of flexion).  There was evidence of swelling of the right knee at the MEB NARSUM examination and non-ratable but limited motion of the right knee noted at the VA examination to support a 10% rating coded as 5099-5014 (analogous to osteomalacia), and analogous code for chondromalacia patella.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  Although the CI had a history of meniscal surgery (5259) there was no evidence of meniscal symptoms proximate to separation to support a rating under 5259.  The examinations following the PCL reconstructive surgery 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 this code.  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).  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 chronic right knee pain condition, coded 5099-5014, an analogous code for patellofemoral syndrome.  

Contended PEB Conditions:  Mild Right Shoulder Impingement.  The Board’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 or implicated in the commander’s statement.  The MEB DD Form 2807 dated July 2002 noted the CI had occasional right shoulder pain that had been diagnosed as impingement syndrome.  However, the first treatment note in the STR was a primary care evaluation in August 2002.  The CI reported right shoulder pain for more than a year and the examiner indicated that the CI was in the MEB process for his right knee problems at that time.  The NARSUM indicated a diagnosis of mild right impingement syndrome, but noted that right knee pain caused the CI to be unable to perform the duties of his MOS.  There was no performance-based evidence from the record that the shoulder condition significantly interfered with satisfactory duty performance prior to the initiation of the MEB for the knee condition.  According to DoDI 1332.38 adequate performance of duties prior to being referred into the physical disability process may support a finding of fitness even if the condition may preclude continued service in the military.  After due deliberation, the Board 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 condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5014 IAW VASRD §4.71a.  In the matter of the contended mild right shoulder impingement condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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	
Chronic Right Knee Pain	5099-5014	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

AR20170005261, 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