RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02185
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050403

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

CI CONTENTION:  The CI contends that his service rating should have been higher at the time of his separation, but he was in such a hurry to separate that he agreed to the offered rating.  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 - 20050216	VARD - 20150724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Residuals of Left Knee Meniscal Tear	5259-5260	10%	20150715	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the left knee condition began in July 2002 during a fall while running in formation.  Radiographic studies (MRI) in August 2002 showed normal cruciate and collateral ligaments and no definitive evidence of meniscal tear.  Surgery was recommended, but the CI declined so that he could deploy.  

During the October 2004 MEB examination (recorded on DD Forms 2697, 2807-1 and 2808), 6 months prior to separation, the CI reported frequent wear of a knee brace, constant pain with inability to climb in and out of a truck, stand, squat; locking and giving way; and swelling.  The physical examination showed crepitus with flexion and extension.  

The MEB NARSUM dated 16 November 2004, 5 months prior to separation, noted complaints of pain, crepitus, and frequent episodes of locking while walking, running, and maneuvering stairs.  Physical examination noted a normal gait with tenderness at the medial and lateral joint lines, evidence of meniscal injury, and a ‘click’ with extension; however, there was no evidence of ligamentous instability.  Painful motion was not addressed.  

At the 10 February 2005 physical therapy appointment, 2 months prior to separation, the examiner recorded a “pain free” range of motion (ROM) of 0-120 degrees (normal 0-140).  There was no VA examination in evidence proximate to separation.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the left knee 10%, coded 5259-5260 (removal of semilunar cartilage and limitation of flexion of the leg), based on the C&P examination 10 years after separation, citing painful motion and symptomatic residuals of cartilage removal.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there were consistent complaints of pain on ambulation and evidence of functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257).  Although there was subjective evidence of frequent locking, there was no evidence of recurrent effusions proximate to separation to support a higher rating under 5258.  There was no history of surgery to remove a meniscus to support a higher rating under 5259.  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 10% under any applicable code.  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 pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left knee pain, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Left Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010120, 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