RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2015-02296
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20020510

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “left knee pain” 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 - 20020304		VARD - 20060123	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Left Knee Pain	5299-5003	10%		Unfused Anterior Tubercle, Left Knee	5299-5262	0%	20051108	
COMBINED RATING: 10%		COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY

Left Knee Pain. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in May 2000 while running in physical training. Radiographic studies revealed a tibial tubercle avulsion (bony chip fracture of the lower leg, just below the knee). There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.

At the 7 February 2002 MEB NARSUM examination performed, 3 months prior to separation, the CI reported continued “low level constant pain” in his left knee, which was aggravated by long distance walking, stair climbing, squatting, running and high weight lower body weight training. The MEB physical examination (PE) showed 135 degrees of flexion (normal 140) and 0 degrees of

extension (normal 0). There was no joint line tenderness and provocative maneuvers to elicit knee instability were negative. Testing for meniscal pathology was painful. The VA Compensation and Pension (C&P) evaluation was performed nearly 3 years after separation; therefore, this panel’s final rating recommendation will be based upon the STR and MEB-driven documents.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition at 10%, coded 5299-5003 (analogously to degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy. The VA rated the left knee condition at 0%, coded 5299-5262 (analogous to impairment of tibia and fibula), citing that “although the evidence indicates nonunion of the anterior tibial tubercle, there is no evidence of left knee or ankle disability: therefore the non-compensable evaluation is appropriate.” The panel agreed that 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). 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) to support a rating under the respective codes. Although the condition was consistent with the clinical pathology of a tibial nonunion and would be appropriately coded under 5262, rating under that code would not be greater than that of 10% for “slight” disability of the knee. There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any other applicable code. After due deliberation, and 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 pain condition 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 20150831, w/atchs Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

AR20170012187, 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,