RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02321
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cryptologic Linguist, medically separated for “chronic right knee pain…” with a disability rating of 0%.  

CI CONTENTION:  The CI makes no contentions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations 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 at the time of separation. The Board 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 Board 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 - 20061016	VARD - 20080430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Left Knee Condition	5260	NSC	20080407	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of anterior cruciate ligament (ACL) reconstruction and lateral meniscus release in 1996 (prior to Service entry) as noted on the entry physical.  The CI developed new onset right knee pain in January 2005 after performing her physical fitness test and feeling the knee lock in a flexed position.  Diagnostic imaging studies (MRI arthrogram) in April 2005 showed evidence of prior ACL reconstruction (intact), prior debridement of the knee with a small medial meniscus, no evidence of acute meniscal injury, and possible acute injury of the patellofemoral ligament.  Further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “right knee pain, secondary to mild patellofemoral pain syndrome and possible mild right arthrosis secondary to prior meniscal injuries” for PEB adjudication.  

The MEB NARSUM examination on 12 July 2006, 4 months prior to separation, noted complaints of intermittent pain of the right knee with occasional locking and swelling.  The physical examination showed a normal range of motion (ROM) of the right knee with no instability and a stable 1A Lachman’s.  There was tenderness at the medial joint line (meniscal sign).  The examiner opined that the CI had undergone a previous right knee ACL reconstruction in 1996 followed by a meniscal repair in the same year and had complete resolution of her right knee problem until she entered the military.  

At the 7 April 2008 VA Compensation and Pension (C&P) evaluation, performed 31 months after separation, the CI reported stiffness, locking and dislocation of both knees and no additional surgeries.  X-rays showed post traumatic degenerative arthritis.  The physical examination showed a normal ROM not limited by pain, fatigue, weakness, lack of endurance or incoordination.  There was no effusion, swelling, locking pain or crepitus.  All other tests for instability and ligamentous laxity were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing full ROM, no effusion and good stability.  The VA did not service-connect the right knee (coded 5260 - leg, limitation of flexion), citing a right knee condition existed prior to service without objective evidence that the condition was permanently worsened by service.  The VA examination had decreased probative value based on its remoteness from separation.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 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) 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).  There was no evidence of painful motion supporting a 10% rating based on §4.59 (painful motion).  The Board noted the CI’s history of meniscal debridement (partial removal) and deliberated if analogous coding to 5259 (cartilage, semilunar, removal of, symptomatic) was potentially applicable.  

The Board adjudged there was sufficient evidence of meniscal surgery with persistent right knee symptoms (based on §4.40 and §4.45) following service aggravation to rate the right knee analogous to 5259 at 10%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition, coded 5299-5259.  

BOARD FINDINGS:  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5259 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board 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 Right Knee Pain	5299-5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150903, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004243, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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