RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2016-00289
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050417

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Interrogator, medically separated for “chronic left knee pain” with a disability rating of 0%.  

CI CONTENTION:  The CI contends that his left knee should have been rated at 10% by the service and that three other conditions, not considered by the service as unfitting, should have been rated 10% each.  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 - 20050203	VARD - 20050913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Residuals, Patella Tendon Repair, Left Knee	5299-5261	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began on 13 June 2003 after an injury sustained jumping during a basketball game.  The CI was found to have a ruptured left patella tendon which was surgically repaired that day.  An MRI done on 8 September 2003, 3 months post-surgery, showed post-traumatic and post-operative changes without abnormality.  The ligaments were intact.  In primary care on 25 November 2003 the CI was noted to have a stable knee on examination; flexion was reduced by pain but the limit not documented.  

At the MEB NARSUM examination performed on 14 December 2004, 4 months prior to separation, the CI reported ongoing pain behind the kneecap.  Running was painful after 5-10 minutes.  The motor function was normal, but quadriceps atrophy was present, apparently citing the August 2004 physical therapy examination.  The atrophy was worse than on a previous examination even though the CI was noted to show improvement.  This same examination (August 2004) also noted a 1 cm difference in strength (not circumference which does not make sense) and a few months later the CI was noted to have normal strength.  The probative value of the August 2004 physical therapy examination is accordingly reduced.  The range of motion (ROM) was based on the same physical therapy examination.  Painful motion was not recorded although the CI reported that single leg squats remained painful.  Flexion was slightly limited at 127 degrees (normal 140), but the unaffected right knee was 129 degrees, essentially symmetric.  The CI was noted to have normal strength and ROM on the DD Form 2808 (21 October 2004).  The CI did not report for some VA Compensation and Pension (C&P) evaluations and cancelled others.  The VA did subsequently rated the knee condition 10%, but based on an examination 10 years after separation and not probative for rating at separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded analogously as 5099-5003 (degenerative arthritis).  The VA also rated the left knee condition 0%, coded analogously as 5299-5261 (leg, limitation of extension of), noting that there was not a VA C&P examination in evidence.  The panel determined that the evidence did not support the presence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The panel did note that a single left squat was limited by pain; however, this a provocative maneuver and not a normal activity.  The limitation of motion was not compensable and there was no evidence of instability or meniscal injury.  No additional functional limitation was evidenced by the examinations.  Therefore the panel concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  

BOARD FINDINGS:  In the matter of the chronic left knee pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160504, w/atchs
Exhibit B.  Service Treatment Record

AR20170015253, 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