RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01894
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “chronic pain, left knee, due to collateral ligament sprains” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20050428	VARD - 20051116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee, Due to Collateral Ligament Sprains	5099-5003	10%	Residuals, Left Knee Injury with Multiple Ligament Tears	5260	10%	20060905	
Headache	Not Unfitting	Migraine Headaches	8100	30%		
Left Lobe Pneumonia		Residuals Pneumonia	6699-6600	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Knee, Due to Collateral Ligament Sprains.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in December 2004 while performing a fireman’s carry.  Diagnostic imaging studies (X-ray) on 4 December 2004 showed a small suprapatellar knee joint effusion.  There was no evidence of fracture, dislocation, or degenerative disease.  Diagnostic imaging studies on 8 December 2004 indicated a large knee joint effusion with contusions of the medial distal femoral condyle and lateral proximal tibial plateau.  There were no fractures noted.  There was a Grade I strain of the medial collateral ligament and iliotibial band, with a partial tear of the proximal lateral collateral ligament.  There were no cruciate ligament abnormalities and no suggestion of acute patellar dislocation.  

There was no recent surgical indication and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  However, the CI’s left knee tibial tubercle advancement surgery for recurrent patellar dislocations performed in 1991, prior to entering military service, was evident on the MEB NARSUM examination.  The MEB forwarded “left knee collateral ligament sprains,” for PEB adjudication.  

During the 5 April 2005 MEB examination, 1 month prior to separation, the CI reported left knee pain that prevented her from performing her military duties and from walking or standing for prolonged periods.  She was able to perform her daily activities, but with some delay due to the left knee pain.  Physical examination showed no effusion and examination tests for ligamentous instability and meniscus pathology were negative.  There was tenderness to palpation diffusely about the knee joint line, both medially and laterally.  However, there was no tenderness upon movement of the patella and no tenderness to palpation about the tibial tubercle, which was prominent due to previous surgery.  There was a well-healed scar from surgery on the anterior knee, just above anterior to the tubercle.  The range of motion (ROM) was extension to -5 degrees (normal 0) and flexion to 140 degrees (normal 140).  The MEB physical on DD Form 2808, performed the same date, documented an antalgic gait.  

At the 5 September 2006 VA Compensation and Pension evaluation, performed 16 months after separation, the CI reported constant left knee pain.  The pain was aggravated by any type of movement, including negotiating steps and partially squatting.  The pain prevented her from running.  The pain was relieved by medication (Motrin and Tylenol).  At the end of each day the knee buckled with each step due to muscle fatigue.  The CI denied any locking of the left knee.  Physical examination showed normal gait, sensation, and strength.  Examination tests for ligamentous instability and meniscus pathology were negative.  There was a well-healed, non-tender anterior scar.  There was also non-tender arthroscopy scars.  The ROM was slightly limited in flexion by pain to 120 degrees and extension was 0 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (arthritis, degenerative), citing collateral ligament sprains and also citing the US Army Physical Disability Agency pain policy (AR 635-40).  The VA rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), citing painful limitation of flexion.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion (or antalgic gait) with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  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).  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 therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 left knee pain condition.

Contended PEB Conditions:  Headache and Left Lobe Pneumonia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended headache and left lobe pneumonia conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150629, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009256, XXXXXXXXXXXXXXXXXX

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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