RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02206
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Unit Supply Specialist, medically separated for “chronic left knee pain” with a disability rating of 10%.

CI CONTENTION:  Evidence supports higher 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 - 20061013	VARD - 20070801	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Strain/Sprain with Medial Meniscal Tear, Left Knee	5010	10%	20070405	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Chronic Left Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI stepped into a hole and twisted his left knee while deployed in 2003.  Radiographic studies (MRI) on 21 May 2005 revealed extensive degenerative changes of the menisci and tri-compartment chondromalacia (osteoarthritis).  There was no surgical indication.

The 12 September 2006 MEB NARSUM examination, 3 months prior to separation, noted left knee pain greatly exacerbated by strenuous activities and prolonged walking.  Physical examination revealed left knee tenderness but no effusion, edema, erythema or warmth.  Goniometric range of motion (ROM) was flexion to 125 degrees (normal 140) with painful motion.  Extension was not addressed.  At the 28 February 2007 VA primary care clinic, 2 months after separation, the CI reported chronic left knee pain since being in the military.  Physical examination showed a mildly antalgic gait.  Ligaments were strong and instability maneuvers were normal.  ROM was normal with painful motion (measurements were not provided).

At the 5 April 2007 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported daily chronic weakness, stiffness, swelling, heat, give way, lack of endurance, locking and constant pain in both knees, which radiated to both shins.  He reported the inability to function without medication during the pain, but that there was no functional impairment.  His physical examination revealed flexion to 140 degrees and extension to 0 degrees (normal) without painful motion.  Repetitive use of the left knee caused pain but no fatigue, weakness, lack of endurance, incoordination, or additional degrees of limitation.

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 pain policy.  The VA also rated the left knee condition 10%, coded 5010 (arthritis, due to trauma), based on the C&P examination 4 months after separation, citing positive X-ray findings for boney exostosis in the medial aspect of the proximal tibia.

Panel members agreed there was no limitation of motion which supported 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 adjudicated by the PEB.  There was no STR history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under those respective codes.  There was no fracture, nonunion, 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.

BOARD FINDINGS:  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20150812, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012123, 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.

A copy of this decision has been provided to the counsel you listed on your application, McGuire Hunter Holmes Hospital, VA Representative, 1201 Broad Rock Blvd, Richmond, VA 23249-0001.

Sincerely,