RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00227
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090513

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E6, Unit Supply Specialist, medically separated for “arthrofibrosis of left knee” with a disability rating of 10%.

CI CONTENTION:  The CI requested a review of 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 - 20090121	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthrofibrosis of Left Knee	5099-5003	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Arthrofibrosis of Left Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained an uncomplicated tibial plateau fracture (tibial eminence only) in December 2006.  He failed to recover a satisfactory knee range of motion (ROM) when treated in a cast; and, in April 2007 (2 years before separation) he underwent an arthroscopic debridement (no intraoperative note of meniscal or ligamental injury).  The pain persisted in spite of a protracted attempt at rehabilitation, and no further surgical intervention was indicated.  Clinical entries in the STR documented recovery of a normal gait, no persistent effusion, no instability, and no indication of impingement (locking).  There were multiple STR entries that included ROM measurements.  These noted flexion in the range of 120-130 degrees (normal 140, 45 for minimum 10%) and consistently recorded minus 5 degrees extension (normal 0, minus 10 degrees for minimum 10%).  Follow-up X-rays demonstrated a healing fracture.  

The 7 October 2008 NARSUM examination, 7 months prior to separation, documented nonspecific pain and “particularly the inability to obtain full extension” that limited “running, heavy lifting, prolonged walking or standing, [and] crawling.”  The physical examination recorded healed surgical incisions and joint stability, but did not comment on tenderness, effusion, or signs of impingement.  The ROM measurements were flexion to 125 degrees and minus 5 degrees extension, without comment regarding painful motion.  Formal goniometric ROM measurements for the MEB were conducted by physical therapy (16 December 2008, 9 weeks later).  These were average flexion to 130 degrees and average extension of minus 5 degrees, specifying the absence of painful motion.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the arthrofibrosis of left knee condition 10%, coded analogously as 5003 (degenerative arthritis), citing functional loss due to factors such as pain, including pain on repeated use and painful motion, fatigability, incoordination, weakness with repetitive use, and flare-ups.  

There was no evidence for ROM limitation, persistent effusion and locking, or instability to support a rating higher than 10% under any applicable code.  The panel also considered analogous rating under code 5299-5262 (tibia and fibula, impairment of) which offers ratings for contiguous knee disability; but, members agreed that the 20% criterion of “moderate” disability was not reasonably supported by the functional evidence (normal gait and mobility with limitations confined to fairly strenuous activities at the time of the NARSUM).  

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 of the left knee condition.

BOARD FINDINGS:  In the matter of the arthrofibrosis of left knee condition and IAW VASRD §4.71a, the Board 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 20160415, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014140, 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,					      
						      					
Enclosure