RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00242
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Construction Equipment Repairer, medically separated for “right knee pain,” with a disability rating of 10%.  

CI CONTENTION:  “Review 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 - 20061024	VARD - 20140709	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	Status Post Right Knee Meniscectomy with Residuals, Limitation of Extension	5259-5261	10%	20140527	
			Status Post Right Knee Meniscectomy with Residuals, Instability	5257	10%		
Chronic Gastritis	Not Unfitting	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first reported a knee injury in 1995.  He was apparently able to meet duty requirements until he reinjured it in 2003 while deployed.  He subsequently underwent his first right knee surgery in January 2004 for medial and lateral meniscal repair (the meniscus is an internal cartilage cushion).  Unfortunately, the meniscal repair failed and a revision surgery took place in June 2005 for right knee degenerative changes (of the cartilage) and repairs of the medial and lateral meniscal tears.  An examination during surgery showed that the menisci were intact and stable.  Ligamentous laxity was not present on examination.  Despite surgery and rehabilitation, he did not improve sufficiently to allow unrestricted duty due to persistent pain.  At an orthopedic clinic evaluation on 15 August 2006, the CI reported chronic pain and that he was unable to load bear on the knee, kneel or squat.  On examination, the CI exhibited full range of motion (ROM).  A positive patellar grind test (pain was elicited with compression of the kneecap) and crepitus (an abnormal grinding sensation or sound) were present, consistent with pathology of the kneecap.  The knee was stable without laxity.  Meniscal signs and an effusion were absent.  A follow-up orthopedic appointment on 8 September 2006was essentially unchanged except that the patellar grind was now negative.  X-ray studies that day showed degenerative changes unchanged from prior x-rays.  

The MEB NARSUM was dated 19 Sep 2006 and accomplished by an emergency services physician.  It referred to the DD 2808 physical examination, accomplished by the same physician on 10 May 2006.  The CI reported constant pain that prevented him from running, marching, walking more than 200 yards, climb stairs, perform the Army Physical Fitness Test or carry greater than 30 pounds.  The examiner noted the right knee hyperextended to 10 degrees and flexed to 140 degrees.  Tests for instability and meniscal irritation were negative.  The first VA Compensation and Pension evaluation took place nearly 8 years post separation and was too distant provide probative information for the panel.  The ROM evaluations in evidence which the panel weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below. 

Right Knee ROM
(Degrees)	DD 2808 ~7 Mos. Pre-Sep	PT ~4 Mos. Pre-Sep	Ortho ~4 Mos. Pre-Sep	Ortho ~3 Mos. Pre-Sep	
Flexion (140 Normal)	140	140	Full	Full	
Extension (0 Normal)	-10	0			
Comment	Painful Motion Not recorded; Stable Knee	No Painful Motion 	Crepitus/Patellar Grind	Crepitus	
§4.71a Rating	0%	0%	0%	0%	

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency (USAPDA) pain policy, which has since been rescinded.  The VA rated the right knee condition 10%, coded 5259-5261 (cartilage, semilunar, removal of, symptomatic – leg limitation of extension), citing limitation of extension and painful motion, based on an examination over 7 years after separation and not probative for rating purposes at separation.  Additionally, the VA rated the right knee instability at 10%, coded 5257 (other impairment of the knee) citing slight instability.  The panel considered the evidence.  There was no evidence of moderate or marked knee disability to support a 20% or 30% rating under the codes 5255 or 5262 (femur, impairment of/tibia and fibula, impairment of).  There was no limitation of motion (5260, 5261), and no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under the respective codes.  Finally, there was no evidence of ligamentous instability or laxity (at separation) which warranted a rating under the 5257 code.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case, but the maximum 10% rating under that code provided no benefit to the CI.  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 condition.  

Contended PEB Condition:  Chronic Gastritis.  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.  It was judged to meet 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 right knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended chronic gastritis condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  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 «ApplicationDate», w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015138, 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