RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00156
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20040922

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Wire Systems Installer, medically separated for “chronic left knee pain post arthroscopic medial meniscal tear repair” with a disability rating of 0%.

CI CONTENTION:  An additional unfitting condition was not considered.  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 - 20040604	VARD - 20041109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain…	5099-5003	0%	Postoperative Retropatellar Pain Syndrome, Left Knee	5099-5019	0%	20040902	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Left Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in April 2001 for torn medial meniscus.  The CI was placed on a permanent L2 profile in March 2002 with walking as an alternate physical fitness test.  He reported increased left knee pain in March 2003.  Left knee X-rays in 2003 and 2004 were normal and MRI in August 2003 noted posterior cysts (Baker’s cyst-fluid filled cystic structures caused by irritation/inflammation) and was otherwise normal.  No surgery was recommended.

The 3 December 2003 primary care clinic visit, 10 months before separation, noted the CI had chronic left knee pain and a P3 profile.  Physical examination showed a normal gait.  Range of motion was “full” without effusion or crepitus.  Instability and meniscus testing were negative.

At the 21 April 2004 MEB NARSUM examination, 5 months before separation, the CI reported constant left knee pain with prolonged standing or walking, squatting, twisting, or lifting, and with impact activities.  Physical examination showed no edema or effusion.  There was knee tenderness.  Instability and meniscus testing were negative.  Patellar grind was positive.  The 30 April 2004 physical therapy evaluation for MEB ROM showed left knee ROM of flexion to 125 degrees (normal 140) and extension was 0 degrees (normal 0) with limitations of motion due to pain.

At the 2 September 2004 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported left knee pain after surgery.  Physical examination showed a normal gait.  There was no tenderness or effusion.  There was no evidence of recurrent subluxation or locking pain.  Left knee ROM was flexion to 140 degrees (normal 140) and extension was 0 degrees (normal 0) without restriction or pain.  Instability and meniscus testing were negative.  There was normal strength and sensation of the leg.  Deep tendon reflexes were within normal limits.  There was no additional limitation of motion due to pain, weakness, lack of endurance, fatigue, or lack of coordination with repeated motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing no chronic left knee pain after medial meniscus repair without joint laxity.  The VA also rated the left knee condition 0%, analogously coded 5099-5019 (bursitis), based on the C&P evaluation 1 month after separation, citing no limitation of motion or restriction of activity.

The panel agreed there was evidence of persistent pain after semilunar cartilage (meniscus) removal (5259) to support a 10% rating.  However, there was no evidence of frequent locking with recurrent effusions to support a higher rating for dislocated semilunar cartilage (5258).  There was no limitation of flexion or extension that supported a higher rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no fracture, non-union, or malunion of the femur or tibia to support consideration for rating under the respective codes for knee instability or impairment related to long bone conditions (5255, 5262).  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 left knee condition, coded 5259.

BOARD FINDINGS:  In the matter of the left knee pain condition, the panel unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  There are 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	
Chronic Left Knee Pain	5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160218, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014083, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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