RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02585
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020719

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

CI CONTENTION:  The CI contends conditions not identified by the MEB or PEB.  The CI’s 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 - 20020625	VARD - 20030811	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	S/P Synovectomy, Left Knee	5260-5020	10%	20030707	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in November 2001 for diffuse synovitis with grade I chondromalacia.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded left knee pain for PEB adjudication.  

The range of motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Left Knee ROM
(Degrees)	Ortho ~6 Mos. Pre-Sep	PT ~5 Mos. Pre-Sep	Ortho ~3 Mos. Pre-Sep	VA C&P ~12 Mos. Post-Sep	
Flexion (140 Normal)	135	133		130	
Extension (0 Normal)	0	0		0	
Comment:  Surgery ~8 Mos. Pre-Sep	Patellar grind	Motor decrease 4+/5 with pain	Retropatellar popping with ROM	Pain limited motion	
§4.71a Rating	0%	10%	0%-10%	10%	

At the time of the orthopedic clinic appointment on 20 February 2002, the CI reported popping under the patella and pain with walking.  On examination the knee showed no instability, but the examiner felt a “pop” under the patella during movement.  The ROM measurements are listed in the chart above.  At a follow-up orthopedic clinic appointment on 8 April 2002, the CI stated the knee popping and pain continued, but he was able to run short distances, up to a mile and a half, intermittently.  Physical examination revealed no effusion or tenderness to palpation, normal motor strength and patellar popping with movement.  The MEB NARSUM, 7 May 2002, noted negative effusion, normal motor strength, joint line tenderness and no instability.  The document did not list any ROM measurements, but stated “there is a pop under the patella with range of motion.”  Radiographic studies on 3 June 2003 showed no bony abnormality.  

At the 7 July 2003 VA Compensation and Pension (C&P) evaluation, performed 12 months after separation, the CI reported his left knee “pops out” and causes pain when this occurs.  Physical examination showed tenderness to palpation with no ankylosis, laxity, subluxation, locking, effusion or crepitus.  ROM measurements are recorded in the chart above.  The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis, citing the US Army Physical Disability Agency (USAPDA) pain policy (AR 635-40).  The VA rated the left knee condition 10%, coded 5260-5020 (leg limitation of flexion - synovitis), citing pain limited motion.  

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 pain limited 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 Board recommends a disability rating of 10% for the left knee pain condition, coded 5299-5260.  

BOARD FINDINGS:  In the matter of the left knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5260 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	
Left Knee Pain	5299-5260	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004634, 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