RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00633
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040511

SUMMARY OF CASE:  Data extracted from the available evidence of record reflcects that this covered individual (CI) was an active duty E4, Construction Equipment Repairer, medically separated for “right knee pain” with a disability rating of 10%.

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 - 20040212	VARD - 20040507	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	Right Knee Chondromalacia Patella with Degenerative Changes	5010-5260	10%	20040407	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in April 2003 for chondromalacia patellae.  At the 26 August 2003 orthopedic clinic examination, 9 months prior to separation (4 months after surgery), the CI was being followed up for a post-operative medial portal infection.  Physical examination showed the infection had cleared, but there was pain and tenderness at the portal site.  The right knee had additional tenderness along the medial anterior joint line with good patellar mobility, no crepitus, and no ligamentous laxity.  The right knee had “full range of motion [ROM]”; painful motion was not addressed.  During the 3 December 2003, MEB examination (recorded on DD Forms 2807-1 and 2808) 5 months prior to separation (8 months after surgery), the CI reported “jolts of pain” with right knee swelling from “time to time.”  Physical examination right knee edema and tenderness.  ROM was full and active; painful motion was not addressed.  At the 17 December 2003 MEB NARSUM examination, 5 months prior to separation (8 months after surgery), the CI reported continued difficulty with running, climbing stairs, squats, load bearing, marching and performing other duties required of his military specialty.  Physical examination revealed the CI walked with a slight antalgic gait, secondary to pain in his right knee.  ROM was extension to 0 degrees (normal 0) and flexion to 130 degrees (normal 140) with painful motion.  Strength testing was normal.  Instability testing was negative.  Neurovascularly testing was intact.

At the 7 April 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation (12 months after surgery), the CI reported marked difficulty climbing up and down stairs and mild pain after prolonged sitting.  Physical examination showed the CI with normal posture and gait.  Crepitus was noted bilaterally.  Instability testing was negative.  There was no redness, warmth or swelling about the right knee.  Normal strength, sensation, and reflexes were noted.  The CI was neurovascularly intact in his lower extremities.  ROM was flexion to 137 degrees and extension to 0 degrees with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing ROM of 0-130 degrees, no ligamentous laxity and no focal neurovascular deficits.  The VA also rated the right knee pain condition 10%, analogously coded 5010-5260 (degenerative arthritis due to trauma-leg, limitation of flexion), based on the C&P examination 1 month before separation, citing full ROM with pain on 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 painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) documented by the NARSUM and VA examinations and adjudicated by the PEB.  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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee pain condition.

BOARD FINDINGS:  In the matter of the right knee pain condition and IAW VASRD §4.71a, the panel unanimously 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 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016331, 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