RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00695
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040423

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

CI CONTENTION:  He was not afforded an opportunity to recover from left knee surgery prior to separation and his left knee replacement caused his right knee to require surgery.  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 - 20040107	VARD - 20040916	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Patellofemoral Syndrome, Residual of Anterior Cruciate Ligament Repair with Scar, Left Knee	5014-5260	10%	20040812	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgery in September 2002 for left knee ACL reconstruction and again in October 2003 for left knee arthroscopy.  Following surgery further treatment to include physical therapy did not result in improvement sufficient to allow unrestricted duty.  

During the December 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported left knee “pain, swelling and popping” that hindered his ability to climb on and off aircraft.  Physical examination noted the CI’s left knee chondromalacia.

The 16 December 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of left knee popping and painful swelling and the inability to bend the left knee to kneel or squat.  Physical examination showed no joint line tenderness, with intact light touch and 5/5 motor strength.  Patellar crepitus and some popping with full extension was noted.  The left knee was ligamentously stable to varus, valgus and Lachman testing with a negative pivot shift test.  Range of motion (ROM) was recorded as 0 degrees extension (normal) and 135 degrees flexion (normal 140).  X-rays showed a well-placed ACL graft and implants with no arthrosis noted.  

At the 12 August 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported intermittent left knee pain once a day lasting 3-4 hours with occasional “giving way.”  The CI denied any locking of the left knee.  Physical examination showed no swelling, redness, or heat; as well as no tenderness to manipulation of patellae.  Medial/lateral collateral and anterior/posterior cruciate ligaments were without laxity with a negative Apley's test.  ROM was recorded as 0 degrees extension and 140 degrees flexion.  Gait and stance were normal as well as heel-to-toe walk.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee pain 0%, coded 5003 (arthritis, degenerative), citing moderate intermittent pain.  The VA rated the left knee pain 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination 4 months after separation, citing “painful left knee joint limiting ability to squat, and requiring intermittent use of medications.”  
  
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).  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 those 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).  There was therefore no VASRD §4.71a rating higher than the 10% 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 left knee pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic left knee pain condition, the panel unanimously recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160913, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016864, 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