RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2015-02225
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050706

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E4, Health Care Specialist, medically separated for “injured left knee” with a disability rating of 0%.

CI CONTENTION: “Review of 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 - 20050615		VARD - 20060916	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Injured Left Knee…	5099-5003	0%		Left Knee Condition	5014	NSC	20060313	
COMBINED RATING: 0%		COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Injured Left Knee. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began sometime prior to 1999. The CI had arthroscopic surgery to remove a symptomatic medial plica in March 1999 prior to service which she reported did not help her pain. She was evaluated and profiled for her left knee pain multiple times in 2002 and 2003 through her training. At a January 2003 orthopedics consultation the orthopedic surgeon recommended considering an “EPTS discharge.” The CI reported that her left knee pain increased in May 2004, she complained of anterior and lateral knee pain that radiated up her thigh and down her leg to the lower leg to the ankle while running, similar to the complaint that was recorded in January 2002. Radiographic studies were normal, showing no arthritis or structural abnormalities. An 11 December 2004 MRI revealed a normal left  knee  with  no  internal  derangement.    There  was  no  further  surgical  indication,  and

conservative treatment, including several intraarticular steroid injections and many physical therapy visits did not result in sufficient improvement.

The 29 April 2005 MEB NARSUM, 2 months before separation, noted the CI had pain directly behind the kneecap and the medial aspect of the knee. The pain was present all of the time and was made worse with cold, damp weather, climbing, knee bending, prolonged standing or walking, jumping and squatting. The examiner recorded she was unable to remain on her feet ambulating on the wards for prolonged periods as required in a hospital setting for her military occupational specialty. The physical examination noted full, active range of motion (ROM) with discomfort over the mid patella, medial joint line and along the medial collateral ligament areas. There was positive retropatellar crepitus with mild discomfort. There was no effusion or patellar laxity. There was mild left quadriceps atrophy noted.

At the 13 March 2006 VA Compensation and Pension (C&P) evaluation, performed 9 months after separation, the CI reported weakness all the time, stiffness, swelling, giving away, and lack of endurance. She complained she could not run, climb stairs or do sit-ups. She also reported a single incapacitating episode over the preceding year, which lasted for 7 days. She missed work twice per month which she attributed to knee pain. The physical examination showed an abnormal gait, left knee ROM was flexion 110 degrees (normal 140) and extension 0 degrees (normal) with pain occurring at 80 degrees of flexion. There was edema, guarding of movement and sounds of ‘popping’. Joint effusion, tenderness and painful motion were present. Repetitive motion did not cause fatigue, weakness or lack of endurance.

The PEB rated the left knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing full range of knee motion without instability and normal imaging. The VA did not service- connect the left knee condition, coded 5014 (osteomalacia), citing medical evidence failed to show the disability had been clinically diagnosed.

There was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 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). No additional functional limitation was evidenced by the examinations. There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45). 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 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 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 20150818, w/atchs Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

AR20170012147, 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,