RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01924
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050309

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Military Police, medically separated for “chronic right knee pain,” with a disability rating of 0%.

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 - 20041201	VARD - 20051113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Right Patellofemoral Syndrome	5299-5260	NSC	20050819	
Von Hippel-Lindau Disease	Not Unfitting	Von Hippel-Lindau Disease	6099-6011	NSC	20050812	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI entered the military with a waiver for surgery on his right knee following dislocation of the kneecap.  The right knee began bothering him again in 2002 with no specific trauma or injury reported.  Radiographic studies performed in 2003 and 2004 suggested an old injury and degenerative changes.  Despite treatment, the right knee could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.

During the 30 September 2004 MEB examination (recorded on DD Forms 2807 and 2808), 5 months prior to separation, the CI reported moderate-severe right knee pain with locking and “giving out.”  Physical examination showed pain “below the kneecap,” especially when the knee was flexed or extended, with no crepitus (popping or grinding noise or sensation).  Testing for ligamentous instability was negative and the kneecap did not shift out of position with movement of the knee.  Range of motion (ROM) was recorded as full (normal 0-140).

The 12 November 2004 MEB NARSUM, 4 months prior to separation, reported complaints of constant, dull right knee pain rated 4/10 in severity (10 being the worst), worsened with walking, stairs, or deep knee bends, preventing running or jumping, and relieved by rest.  Physical examination noted tenderness of the tendon that attaches the kneecap to the lower leg.  Provocative testing was suggestive of pain in the kneecap.  With flexion and extension, the kneecap was observed to shift laterally, an indicator of kneecap instability.  There was some lateral movement of the kneecap but no complete dislocation of the kneecap when the kneecap was shifted laterally (to the side).  Neurologic examination of the lower extremity was normal, and ROM was again recorded as full.

At the 19 August 2005 VA Compensation and Pension evaluation, performed 5 months after separation, the CI reported constant right knee pain that prevented him from running, jumping, or lifting weight.  The knee reportedly felt weak and would give out.  Physical examination showed his gait within normal limits.  ROM was recorded as 0-140 degrees (normal) and was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  Testing for ligamentous instability and cartilage injury were negative.  Neurologic examination was normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing no loss of joint motion.  The VA did not service connected the right knee condition, citing a lack of objective evidence of permanent worsening of the condition due to military service.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The panel considered those VASRD paragraphs and concluded that tenderness (as reported by the NARSUM) was insufficient evidence of painful motion to merit a 10% disability rating.  Gait was reported as normal.  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), nor was there a documented history of recurrent subluxation, 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.  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 condition.  

Contended PEB Condition:  Von Hippel-Lindau Disease.  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 or implicated in the commander’s statement or 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 recommends no change in the PEB adjudication.  In the matter of the contended Von Hippel-Lindau Disease, the panel recommends no change from the PEB determinations as not unfitting.  There were 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 20150710, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009295  , 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