RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00235
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistics Specialist, medically separated for “chronic left knee pain” with a disability rating of 0%.  

CI CONTENTION:  “Conditions have worsened since initial rating.  VA has rated me substantially more than Army Board.”  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 - 20060616	VARD - 20071107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic left knee pain	5099- 5003	0%	Iliotibial Band Friction Syndrome of the Left Knee with Chronic Pain and Bone Spurs	5257-5010	10%	20070917	
Plantar Fasciitis	Not Unfitting	Plantar Fasciitis, Left Foot	5284	0%	20070917	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in September 2003 while on a unit run.  Radiographic imaging (X-ray in November 2005 and magnetic resonance imaging in December 2005) documented patellar spurring and discrete meniscal tears, with no evidence of fracture, dislocation, ligamentous disruption, effusion or inflammation.  At a 2 February 2006 orthopedic consultation, surgical options were discussed, but the CI declined.  

At the 26 April 2006 MEB NARSUM examination, 5 months prior to separation, the CI reported persistent left knee pain aggravated by prolonged sitting or standing and performance of routine duties or physical fitness activities.  Physical examination noted infrapatellar tenderness and a normal gait.  The range of motion (ROM) was flexion to 140 degrees (normal) with pain past 90 degrees, and extension to 0 degrees (normal).  Provocative testing for ligamentous instability, laxity or meniscal injury was negative.  

At the 17 September 2007 VA Compensation and Pension (C&P) evaluation, performed 11 months after separation, the CI reported daily pain and intermittent swelling, but denied current use of braces, assistive devices, incapacitating episodes or flare ups.  Physical examination showed a normal gait with no evidence of tenderness, swelling, effusion, crepitus, ligamentous instability, or meniscus injury.  ROM measurements documented flexion to 130 degrees and extension to 0 degrees without pain; however there was pain with lateral patellar displacement.  

The panel 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 “rated for pain—minimal, occasional” with likely application of the US Army Physical Disability Agency pain policy and (AR 635-40).  The VA rated the left knee condition 10%, coded 5257-5010 (recurrent subluxation or lateral instability of the knee due to traumatic arthritis), citing painful or limited motion of a major joint.  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).  However, there was evidence of painful motion, radiographic evidence of arthritis, and functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45), analogously coded 5099-5003.  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 higher 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).  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 5099-5003.  

Contended PEB Condition:  Plantar Fasciitis.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic left knee pain condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended plantar fasciitis condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160411, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015125, 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