RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2016-00438
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070920

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

CI CONTENTION:  “I was rated at 0% by the US Army and only my right knee was considered.  The VA rated my right knee at 10% and also my left knee and hypertension.”  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 - 20070824	VARD - 20071026	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis, Right Knee	5003	0%	Degenerative Joint Disease of Right Knee Joints	5260-5010	10%	20070823	
Hypertension	Not Unfitting	Hypertension	7101	10%		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Osteoarthritis, 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 2001 after tripping on a rock and falling on his knee.  After conservative treatments his pain initially improved.  Pain increased in June 2006 while deployed to Iraq when his knee buckled and he fell down.  There was no surgical indication.  Despite further treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.  
Magnetic resonance imaging (MRI) study performed 27 October 2006, showed no internal derangement, but there was evidence of joint effusion and mild degeneration of the meniscal cartilage with no tear.  Follow-on plain film weight bearing radiographic studies, 6 June 2007, showed no narrowing of the joint line or other evidence of arthritis.  At the 21 July 2007 MEB NARSUM examination, 2 months prior to separation, the CI reported constant knee pain with exacerbations caused by carrying weight, running, stooping, kneeling, jumping or sudden weight shift.  After heavy use, the knee would swell.  The examiner noted no effusion or crepitus of the knee.  Range of motion (ROM) measurements were reported as flexion to 135 degrees compared with 140 degrees on the left (normal 140) and extension to 0 degrees (normal) with increased pain on movements of the right knee.  

At the 23 August 2007 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported stiffness, swelling, and chronic pain rated 5/10.  Physical examination showed flexion to 135 degrees (normal 140) and extension to 0 degrees (normal) with objective evidence of painful motion present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition 0%, coded 5003 (degenerative arthritis), citing no ratable limitation of motion.  The VA rated the right knee condition 10%, dual coded 5260-5010 (leg limitation of flexion – arthritis due to trauma), citing painful or limited motion.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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, nonunion, 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).  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 pain condition, coded 5299-5260.  

Contended PEB Condition:  Hypertension.  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, 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 osteoarthritis, right knee condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5260 IAW VASRD §4.71a.  In the matter of the contended hypertension condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  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	
Osteoarthritis, Right Knee	5299-5260	10%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160707, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015624, 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