RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02011
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050405

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Metal Worker, medically separated for “chronic pain left knee with fibrous cortical defect of distal femur of no clinical significant and patellar chondromalacia” 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 - 20050309	VARD - 20050416	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee …	5099-5003	10%	Left Knee Strain	5260	10%	20050304	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Knee.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in 2002 while on a run.  

Range of motion (ROM) measurements conducted by a physical therapist on 22 February 2005, 1 month prior to separation, were 2-140 degrees (normal 0-140) with an absence of painful motion.  The NARSUM examination the following day (23 February 2005) noted complaints of constant left knee pain since joining the military.  The benign tumor was monitored by X-rays.  Physical examination showed no left knee swelling.  Tenderness of the knee was present along with mild crepitus (crackling or grinding noise or sensation in the joint).  The CI had a non-antalgic gait.  During 1 March 2005 examination (recorded on DD Forms 2807-1 and 2808) the CI reported a non-ossifying fibroma growth (benign tumor) on his left leg.  Physical examination showed a positive patellar grind and negative laxity.  

At the 4 March 2005 VA Compensation and Pension (C&P) evaluation the CI reported constant dull aching left knee pain, which hurt with running or walking fast for long distances.  Physical examination showed a gait within normal limits.  Crepitus was present.  ROM was recorded as 0-94 degrees, with ROM limited by pain, but not additionally limited by repetition.  X-ray evidence revealed a normal knee.  The examiner noted the claimed condition was patellar chondromalacia, left knee with the diagnosis of left knee strain.  The distal femur tumor was not claimed, examined or imaged.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic pain, left knee 10%, coded 5099-5003 (analogous to arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA also rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination 1 month before separation.  Panel members agreed that the benign nonossifying fibroma was appropriately subsumed under the PEB’s chronic knee pain rating.

Panel members agreed there was no limitation of motion to support a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as documented by both MEB NARSUM and C&P examinations.  There was no knee ankylosis (5256) or impairment (5257) marked by recurrent subluxation or lateral instability and 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), albeit the presence of a benign tumor for the distal femur.   Therefore, there was no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 left knee condition.

BOARD FINDINGS:  In the matter of the left knee conditions and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20150717, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011062, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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,