RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00254
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070712

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O4, Personnel Systems Management, medically separated for “injury to right knee”, with a disability rating of 0%.  

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 - 20070622	VARD - 20060927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Injury to Right Knee	5099-5003	0%	Right Knee Meniscal Tear Status Post Arthroscopic Debridement 	5262	NSC	20060126	
			Scars, Right Knee	7802	NSC	20060126	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Right Knee Injury.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery (partial medial meniscectomy) in April 2005.  Radiographic imaging (MRI) in February 2007 documented intact anterior and posterior cruciate ligaments (ACL and PCL respectively), medial and lateral collateral ligaments (MCL and LCL respectively), and extensor mechanisms with a tear (“likely degenerative”) of the posterior horn of the medial meniscus.  Further imaging in March 2007 documented narrowing of the medial joint space indicative of early osteoarthritis.  Surgery was not recommended.  

At the 26 January 2006 VA Compensation and Pension (C&P) general medical evaluation, 18 months prior to separation, the CI reported persistent swelling, pain in cold weather, and after prolonged walking and periods of increased activity.  She reported wearing a knee brace “most of the time, and “buckling” 3 to 4 times per month without locking.  Physical examination showed crepitus and a small effusion.  There was tenderness below the patella and numbness along the lateral knee.  Range of motion (ROM) was from 0-130 degrees (normal 0-140) with anterior laxity and no evidence of lateral instability.  There was no weakness, incoordination, or fatigability noted after repetition.  

The MEB NARSUM examination on 8 March 2007, 4 months prior to separation, noted complaints of pain when standing greater than 2.5 hours, walking more than 1.5 miles, or sitting for more than 1 hour.  Physical examination showed an antalgic gait with atrophy of the thigh.  There was guarding against movement and manipulation however no evidence of instability.  There was no tenderness or effusion and patellar compression did not evoke pain.  ROM was from 0-105 degrees.  Pain was not addressed.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the right knee condition, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA did not rate the right knee condition as it was determined to be not service connected based on the VA C&P examination 18 months before separation as well as the unavailability of STRs for the period during which the CI had injured her right knee and had subsequent surgery in service.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 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) 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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case, and provided an alternate route to a 10% rating.  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 right knee condition, coded 5259.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  There were 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	
Right Knee Pain Status Post Surgery	5259	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160430, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014145, 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