RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX		CASE: PD-2016-00076 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060417

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

CI CONTENTION: The CI made no specific contention. 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 - 20060306		VARD - 20061016	
Condition	Code	Rating		Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	0%		Right Knee Patellofemoral Syndrome	5260	10%	20060804	
COMBINED RATING: 0%		COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Right Knee Pain. According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had surgery on the right knee at age 13 in 1998 which was declared at and cleared for accession. He first was seen for right knee pain 6 months after accession on 17 May 2005. He was treated with medications and duty limitations, but continued to note pain and when seen 2 weeks later had tenderness on examination. The knee was stable and without meniscal signs though. A radiographic (X-ray) study was normal. He reported improvement with rest, but aggravation from running.

At the time of an orthopedic clinic appointment on 3 June 2005, the examiner thought the CI had patellofemoral syndrome (PFS) and continued rehabilitation in the knee class was recommended. An MRI on 4 August 2005 was also normal and specifically cited normal ligaments, menisci

(internal cartilage cushions), and an absent effusion. Despite continued rehabilitation and duty limitations, he continued to have pain which precluded full duty or the completion of training.

At the 27 October 2005 MEB examination (recorded on DD Forms 2807 and 2808), 6 months prior to separation, the CI reported difficulty walking and running and swelling of the right knee. The physical examination showed an overweight CI who required use of a cane for the right knee. The MEB range of motion (ROM) measurements were obtained on 11 November 2005 in physical therapy. On examination the ROM for the right knee after three repetitions was 130 degrees of flexion with tightness and pain at end range (normal 140) and a normal extension of 0 degrees. The unaffected left knee ROM was 0-135 degrees, also slightly less than the VA normal range.

At the time of the orthopedic clinic appointment on 7 December 2005, the CI reported right knee pain since Basic Training and now needed a cane for simple ambulation (walking). The MEB NARSUM examination was dated 16 December 2005, 4 months prior to separation. The CI reported right leg pain from the lower thigh to the upper calf. He also reported that he was unable and an inability to ambulate or stand continuously for greater than 20 minutes or lift greater than 20 pounds. The physical examination showed an overweight CI that ambulated with a cane.

At the 9 March 2006 physical therapy clinic appointment, 5 weeks prior to separation, the CI reported knee pain for the past several months, aggravated by deep knee bends, running and jumping. The examiner noted the CI had been noncompliant with all treatment attempts and refused any rehab (rehabilitation) exercises and had not come off of his cane. Since the MEB his knee pain had dramatically improved. The CI admitted that his low motivation level led to an exaggeration of his previous knee complaints. He denied locking, swelling, or giving way. He declined a referral to the knee class (he had attended, but been non-compliant) and stated that he would resume running on his own. The CI now desired to remain in the US Army. On examination, the gait and the ROM were normal, with pain in flexion with OP (overpressure, presumably). There was tenderness to palpation and pain and weakness on resisted extension. Testing for ligamentous instability and meniscus pathology remained normal.

At the 4 August 2006 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported daily pain in the knee on a scale of 1/10, that increased to 5/10 with activity such as walking 15 minutes, crossing his legs, running, jumping or kneeling. The CI denied use of assistive devices, could drive and function in his job as a security guard, where he sat most of the day. Physical examination showed normal gait and posture. The ROM was 120 degrees of flexion and 0 degrees of extension, both without pain. With repetitive movements and flare-ups, there was an additional 20 degree limitation of ROM secondary to pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the “right knee pain” condition 0%, analogously coded 5003 (arthritis, degenerative), citing normal radiographs, full range of motion and no ligamentous instability. The VA rated the “right knee patellofemoral syndrome” condition 10%, coded 5260 (leg, limitation of flexion of), citing objective evidence of right knee function limited by pain with loss of leg flexion.
There was no evidence of painful motion with functional loss supporting a 10% rating (based on
§4.59, §4.40 and  §4.45). While painful motion  had been  reported prior  to the MEB, the examination most proximate to separation noted that the active ROM was within normal limits (WNL). At this encounter, the CI admitted to exaggeration of his symptoms previously. There likewise was no limitation of motion which attained a minimum rating under the diagnostic codes for limitation of flexion or extension (5260, 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). No additional functional limitation was evidenced by the examinations. Therefore the panel majority concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB. 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 “right knee pain” condition.

BOARD FINDINGS: In the matter of the right knee pain condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication. The single voter for dissent recommended modification to 10%, but did not elect to submit a minority opinion. There were 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 20150811, w/attachments Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

AR20170013283, 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,