RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00026
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “chronic pain, left knee” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 - 20050722	No VA Claim in Evidence	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	10%		
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Left Knee.  According to service the treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in March 2004 when he noted pain during a physical training run which became progressively worse. On 8 June 2004 the CI received arthroscopic surgery of the left lateral meniscus.

A physical therapy and orthopedic examination both performed on 21 July 2004, 4 months prior to separation, showed no effusion or crepitus or patellar pain, the ability to squat/walk with knee pain, motor strength at 5/5 of the bilateral lower extremities, and full active range of motion (ROM).  Instability and laxity were not addressed. 

The MEB NARSUM examination on 20 September 2004, 2 months prior to separation, noted complaints of chronic left knee pain status-post surgery.  
Physical examination showed a normal gait without crepitus.  Instability and laxity were not addressed.  ROM was flexion 131 degrees (normal 140) and hyperextension 5 degrees of (normal 0) with painful motion.  Radiographic imaging (X-ray and MRI) were normal. 

The CI did not file a VA disability claim.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee 10%, analogously coded 5099-5003 (degenerative arthritis), citing application of the US Army Physical Disability Agency pain policy.  There was no VA rating.

The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257).  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 VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160109, with attachments
Exhibit B.  Service Treatment Record

AR20170013186, 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,