RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00395
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Bradley Fighting Vehicle System Maintainer, medically separated for “posttraumatic osteoarthritis of the right knee” with a disability rating of 0%.

CI CONTENTION:  The CI’s condition continues to worsen, and PTSD was not included.  The CI’s 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 -20071017 	VARD - 20080619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Osteoarthritis of the Right Knee	5010	0%	Traumatic Osteoarthritis with Patellofemoral Degenerative Joint Disease, Right Knee	5003-5260	10%	20080609	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Posttraumatic Osteoarthritis of the Right Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in November 2005, when he was involved in an improvised explosive device (IED) blast while deployed to Iraq.  The CI underwent right knee surgery in April 2006 for removal of a large loose body.  He underwent a second operation in March 2007 to correct a large osteochondral defect on the surface of the right patella, likely the source of the previous loose body.  At the 4 May 2007 MEB NARSUM, 8 months before separation, the CI reported constant knee pain, especially with increased activities.  Physical examination showed an antalgic gait.  There was tenderness and crepitus without swelling.  Examination tests for ligamentous instability and meniscal pathology were negative.  There was a positive patellar grind sign.  Knee ROM was flexion 130 degrees (normal 140) and extension 0 degrees (normal 0).  

At the 9 June 2008 VA Compensation and Pension (C&P) evaluation, 6 months after separation, physical examination showed a normal gait.  There was slight effusion and swelling, tenderness, and crepitus, but no swelling.  Examination tests for ligamentous instability and meniscal pathology were negative.  Knee ROM was 140 degrees flexion, without pain and extension 0 degrees, with pain, crepitus, grinding and snapping.  The VA examiner opined that ROM was likely to be additionally limited with repetition to flexion 90 degrees.  The CI was able to heel and toe walk without difficulty.  Right knee X-rays showed degenerative joint disease.  Knee MRI showed small effusion with degenerative changes of the cartilage of the patella and knee joint.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5010 (arthritis, due to trauma), citing arthritis on X-rays and ROM.  The VA rated the right knee condition 10%, coded 5003-5260 (degenerative arthritis-leg, limitation of flexion of), citing evidence of painful motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of arthritis with limited ROM to support a 10% rating coded 5010 at the MEB NARSUM examination and/or painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) noted at the VA examination.  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 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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel unanimously recommends a disability rating of 10%, coded 5003-5260 IAW VASRD §4.71a.  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	
Posttraumatic Osteoarthritis of The Right Knee	5010	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015494, 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