RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02199
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Motor Transport Operator, medically separated for “chronic left knee pain” with a disability rating of 10%.

CI CONTENTION:  “Review all Conditions.”  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 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 - 20071002	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5009-5003	10%	No VA Claim	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Chronic Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI left knee condition was initially treated in April 2006 during basic training after 1 day of atraumatic pain aggravated by weight bearing.  Radiographic imaging (X-ray) was normal.  He was thought to have a strain and given medications, crutches, and limited duty.  In May 2006 the CI reported diminished knee pain and the desire to resume training.  Subsequent radiographic imagining (MRI) showed thickening of the lateral collateral ligament (LCL) consistent with a prior (healed) complete tear.  The anterior cruciate ligament (ACL) also showed evidence of a prior partial tear.  The medial collateral ligament (MCL) and posterior cruciate ligament (PCL) were intact as were both menisci (cartilage cushions inside the knee).

During a 14 September 2006 orthopedics evaluation, 15 months before separation, the CI denied a history of significant trauma to the knee.  He reported ongoing pain with running, squatting, and climbing.  Physical examination revealed a normal gait and a stable knee.  He was thought to have inflammation of the pes anserine (a conjoined insertion of several tendons on the medial aspect of the knee and just below the knee joint) bursa (a fluid filled sac which reduces friction from tendons passing over it).  The CI was noted to have knee pain without a specific etiology.  His condition was not amendable to surgery.  The CI was issued a L3 profile.

During a 14 February 2007 emergency room visit, 10 months before separation, the CI reported falling off a truck which caused more left knee pain.  He was noted to have full but painful left knee ROM.  During a 20 March 2007 physical therapy evaluation, physical examination revealed an antalgic gait and flexion limited to 40 degrees (normal 140) with painful motion.  Three hours later he was seen by primary care which documented a normal appearing left knee with LCL and MCL tenderness but stable.  ROM was normal.

During the 18 September 2007 MEB NARSUM examination performed by orthopedics, 2 months prior to separation, the CI reported injuring his knee in basic training.  He endorsed left knee diffuse pain, the ability to only stand for 5 minutes, the inability to walk greater than 4-5 feet without a cane, and the ability to only walk 100 yards with a cane.  Physical examination showed the CI walked with a cane and hobbled without it.  Active flexion was limited to 30 degrees due to pain.  Extension was not cited.  There was no marked atrophy or effusion noted, and knee stability testing was negative.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The panel noted the MEB examination recorded left knee flexion limited to 30 degrees.  This degree of limited flexion supports a 20% rating for “flexion limited to 30 degrees”, coded 5260 (leg, limitation of flexion).  The panel observed that several prior examinations noted full left knee ROM.  There was no limitation of extension that supported a rating under the VASRD diagnostic code for limitation of extension (5261).  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) 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).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 20% for the chronic left knee pain condition, coded 5260.

BOARD FINDINGS:  In the matter of the chronic left knee pain condition, the panel majority recommends a disability rating of 20%, coded 5260 IAW VASRD §4.71a.  The single voter of dissent recommended no change and elected not to submit a minority opinion.  There are 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	
Chronic Left Knee Pain	5260	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150810, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014673, 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