RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01990
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050923

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

CI CONTENTION:  Reduced ability to perform daily tasks and now reliant on prescribed narcotics.  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 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 panel 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 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 - 20050722	VARD - 20090220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	0%	Left Knee Disorder	5299-5257	NSC	20051128	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Left Knee.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s atraumatic left knee condition began in September 2003 while deployed to Iraq.  Diagnostic imaging (MRI) revealed a normal meniscus and ligaments.  A bone scan revealed increased uptake in the posterior aspect of the left lateral femoral condyle which corresponded with X-ray findings of a bone lesion in the left distal femur.  Surgical intervention was not indicated.  The MEB forwarded left knee retropatellar pain syndrome with large benign appearing bone lesion in the left distal femur for PEB adjudication.

The 29 April 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of his knee giving out, occasional swelling and rare locking.  The physical examination showed tenderness at the medial joint line, and pain and crepitus with patellar grind.  Instability and meniscus testing were negative.  The range of motion (ROM) was 0 degrees of extension to 130 of flexion (normal 0 to 140); painful motion was not addressed.  

The 06 August 2005 MEB NARSUM Addendum, 4 months prior to separation, revealed ROM of 0 degrees extension after 3 repetitions, and 120 degrees of flexion after three repetitions.  The examiner noted that was “no significant pain during range of motion measurements for either knee” and that the limitation of motion was mechanical.  

At the 28 November 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported left knee pain with prolonged sitting or walking more than 15 minutes, and occasional buckling.  The physical examination showed active ROM of 0 degrees extension, and 140 degrees of flexion; “without any complaints of pain or discomfort.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee 0%, analogously coded 5099-5003 (degenerative arthritis), citing application of the US Army Physical Disability Agency.  The VA did not service-connect the left knee condition, coded 5299-5257 (knee, other impairment), based on the VA C&P examination 2 months after separation, citing no evidence substantiating the disability (left knee, osteochondral defect, posterolateral femoral condyle) is related to military service.  

Panel members agreed there was no limitation of flexion or extension that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no evidence of subluxation or lateral instability to support a separate 10% rating under the 5257 code (knee, other impairment).  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).  Although PT evaluation most proximate to separation and VA examination noted the absence of painful motion, the NARSUM examination noted painful motion for a 10% rating.  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 5299-5260.  

BOARD FINDINGS:  In the matter of the chronic pain left knee condition, the panel majority recommends a disability rating of 10%, coded 5299-5260 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 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 Pain Left Knee	5299-5260	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150702, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010022, 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.

Sincerely,	
Enclosure