RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2015-02325
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060114

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Infantryman, medically separated for “right knee pain” with a disability rating of 0%.

CI CONTENTION: The CI made a contention for his knee, as well as other conditions awarded by the VA. 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 at the time of separation. The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation. 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 - 20051213 			 	VARD - 20060726 		
Condition	Code	Rating		Condition	Code	Rating	Exam	
Right Knee Pain	5099- 5003	0%		Right Knee Retropatellar Pain Syndrome	5260	0%	STR	
COMBINED RATING: 0%		COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Right Knee Pain. According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in May 2004 after kicking in several doors during combat operations while deployed. Magnetic resonance imaging (MRI) performed on 27 September 2004 revealed a small probable ganglion cyst with no evidence meniscal tear or cruciate ligament rupture; however, a relative increased signal within the fibers of the anterior cruciate ligament (ACL) may have represented ACL strain without disrupted fibers.

On 22 October 2004 the CI reported he stepped in a hole and had a mild ACL strain, which was treated with naproxen, a nonsteroidal anti-inflammatory drug (NSAID), and RICE (rest, ice,

compression, and elevation) therapy. The CI underwent physical therapy from June through September 2005 and was seen in the orthopedic clinic on 14 September 2005 with continued knee pain. Examination revealed no laxity or evidence of a meniscal tear and the patellar grind test was negative. Radiographic (X-ray) studies showed evidence of Osgood-Schlatter disease (an inflammation of the patellar ligament at the tibial tuberosity).

The 4 October 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of continued knee pain and giving way that prevented the CI from running. He denied locking or swelling of the knee. Physical examination of the right knee showed no deformity, effusion or warmth. The knee was tender to palpation over the medial joint line and medial aspect of the patella. The range of motion (ROM) measurements showed a normal flexion of 140 degrees and a normal extension of 0 degrees. Motor function and sensation were intact distally. He had a negative McMurray’s test (to determine a meniscal tear) and negative testing for laxity (anterior/posterior drawer, pivot shift, dial-in, and varus/valgus tests); however, he had pain with a patellar grind. An MRI in evidence demonstrated “normal meniscus, ligaments, bone, soft tissue, and articular cartilage. There was a small Baker’s cyst and a small cyst just anterior to the medial meniscus.” The examiner’s diagnosis was right knee retropatellar pain syndrome, which significantly affected the CI’s ability to perform the duties in his Military Occupational Specialty (MOS) both in-garrison as well as in a combat environment.

A MEB NARSUM Addendum noted the active ROM of the right knee showed a flexion of 115 degrees and a normal extension of 0 degrees, with mild pain. During the 1 November 2005 MEB examination (recorded on DD Forms 2807-1 and 2808) 2 months prior to separation, the CI reported swelling of the right knee, “right knee gives out,” “pain level 5-6/10 without activity and 7-8/10 with activity.” Physical examination showed pain on the ROM of the right knee. 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 right knee condition 0%, analogously coded 5003 (arthritis, degenerative), citing a 0% rating for one joint involved. The VA also rated the right knee condition 0%, coded 5260 (leg, limitation of flexion of), citing a non-compensable evaluation.

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) 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). However, there was 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 recommends a disability rating of 10% for the right knee condition.

BOARD FINDINGS: In the matter of the right knee condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. There were 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	
Right Knee Retropatellar Pain Syndrome	5099- 5003	10%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20150823, w/attachments Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Rating Decision

AR20170012487, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX

Sincerely