RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02378
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090313

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, 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 - 20090218	VARD - 20100519	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain, Meniscectomy and Chondroplasty	5099-5003	10%	Chondromalacia Patella, History of Arthroscopy and Medial Meniscectomy	5260	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Left Knee Pain, Status Post Medial Meniscectomy and Chondroplasty Diagnosis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in April 2008 after twisting his left knee during physical training.  No treatment was initially sought, however by June 2008, the CI’s pain worsened.  Magnetic resonance imaging (MRI) on 26 June 2008, revealed no significant findings.  The 11 August 2008 orthopedic consult showed full range of motion (ROM) with crepitus at the patella, positive patellar grinding.  There was no evidence of instability and testing for meniscal pathology (McMurray’s) was equivocal.  
On 15 August 2008, the CI underwent surgery for a repair of a medial meniscal tear (MT) and debridement of degenerative changes of the patella (chondromalacia patella), graded 3-4/4.  By November 2008, the CI was still having a fair amount of pain, difficulty bending his knee, and an inability to run more than 40 feet.  Orthopedic follow-up evaluation noted knee arthritis and released the CI to return to duty and return as needed.  The CI continued physical therapy with minimal change in his symptoms.

The 10 February 2009 MEB NARSUM examination, 1 month prior to separation, noted complaints of constant daily pain aggravated by walking greater than 200 yards.  Pain intensity was rated at 3/10 increasing to 7/10.  Stiffness was reported, but no locking and the CI used a brace during all waking hours.  He was not taking any medications.  Physical examination showed a limp favoring the left.  The CI was able to heel and toe walk with pain.  Lower extremity strength was graded 5/5.  There was tenderness to palpation of the knee joint lines without effusion.  There was no evidence of instability and testing for meniscal symptoms was negative (McMurray’s).  There was significant decrease in left knee flexion, with increased pain but no additional loss of ROM with repetitive motion.  The CI was noted to grimace with movement.  Knee ROM was measured by physical therapy on 9 January 2009 and after three repetitions flexion was 111 degrees and extension 0 degrees.  There was discomfort at end ROM in flexion.  There was no VA Compensation and Pension examination in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (arthritis, degenerative) citing limited ROM due to pain.  The VA rated the left knee condition 0%, coded 5260 (leg, limitation of flexion), based on the service treatment records citing no objective evidence of pain with active motion or objective evidence of pain following repetitive motion. 

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 limited motion of a single major joint with arthritis for 10% rating as adjudicated by the PEB or 10% rating for painful motion with functional loss coded as 5299-5260 (based on §4.59, §4.40 and §4.45).  The persistence of pain after meniscal surgery also supported a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic) as adjudicated by the PEB.  There was no history of frequent locking of the knee with recurrent effusions for higher rating for dislocated semilunar cartilage (5258).  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 therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 20150602, with attachments
Exhibit B.  Service Treatment Record

AR20170012621, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure