RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00629
BRANCH OF SERVICE:  Army 	SEPARATION DATE: 20041006 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E4, Motor Transport Operator, medically separated for “post traumatic arthritis right knee” with a disability rating of 10%.  

CI CONTENTION:  “Increased pain and mobility have gotten worse.  Starting to hinder job duties.”  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 – 20040928	VARD - 20091026	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Traumatic Arthritis Right Knee 	5010	10%	Right Knee Tibial Plateau Fracture with Mild Instability	5257	10%	20090525	
			Right Knee Tibial Plateau Fracture with Limitation of Extension	5010-5261	10%	20090525	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Post Traumatic Arthritis Right Knee.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began 10 September 1999 during physical training with trauma to the right knee and immediate swelling.  Seven weeks later magnetic resonance imaging (MRI) of the knee showed a healing intra-articular fracture of the medial tibial plateau (MTP - proximal tibia) that was not in optimal position, with a gap in the articular surface.  
The CI continued with conservative treatment at that time, but he continued with pain and right knee MRI in October 2002 showed degenerative changes of the MTP and a possible tear of the undersurface of the medial meniscus.  Arthroscopy performed in December 2002, 22 months before separation, showed a healed MTP fracture, traumatic arthritis and depressed articular defect that could not be repaired.  The surgeon recommended permanent restrictions from “heavier weight bearing activity.”  The CI continued to report pain, grinding, and swelling of the knee without instability.

At the 11 June 2004 MEB orthopedic evaluation, 4 months before separation, the CI reported pain and grinding of the knee with all activities, with knee swelling and popping, but no instability.  Physical examination showed a normal gait and the examiner indicated the CI was without symptoms that morning.  There was tenderness to palpation in the medial joint margin of the right knee, but there was full range of motion (ROM) and the knee was stable.  There was no evidence of meniscal pathology.  The CI’s thigh muscle strength was fair, and neurovascular status was intact.  The examiner reported MRI studies documented degenerative changes consistent with medial tibial plateau arthritis.  

The 20 September 2004 MEB NARSUM examination, 1 month prior to separation, noted CI complaints of constant pain, decreased ROM, and a burning sensation under the kneecap.  Treatment with anti-inflammatory medication and heat wraps was minimally helpful.  Physical examination showed the CI walked with a limp favoring the right, and had difficultly performing heel and toe walking.  He jogged slowly with a noticeable limp and grimace.  Right knee ROM was flexion 120 degrees and extension lacked 5 degrees.  The CI performed knee bends to 110 degrees, needing assistance to stand up, and to 80 degrees without assistance, but with noted pain.  The right leg was recorded as straighter than left and appeared shorter than the left, and the left leg had an increased bowleg appearance compared to the right.  There was no VA Compensation & Pension (C&P) examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5010 (arthritis, due to trauma), citing there was no joint instability, however, pain markedly limited duty function.  The VA rated the right knee 10%, coded 5257 (other knee impairment) for slight instability and 10%, coded 5010-5261 (traumatic arthritis-limitation of leg extension) for limitation of extension, based on the C&P examination 59 months after separation.  

The PEB assigned a 10% rating coded 5010 and therefore the panel reviewed to see if a higher rating was supported by the evidence.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The panel majority found there was no evidence of malunion or nonunion of the tibial fracture (5262) to support a rating under this code.  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.  The panel majority concluded there was no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the post traumatic arthritis right knee condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  There are 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 20160914, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016328, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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