RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2016-00746
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Hawk Missile Systems Crewmember, medically separated for “chronic right knee pain” with a disability rating of 0%.  

CI CONTENTION:  The CI contends his right knee is “degrading” and other, out of scope, 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 - 20040217	VARD - 20040907	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Right Knee Condition, Status Post Repair of Patellar Tendon	5010-5262	10%	20040813	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

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 May 2003 when he ruptured his patellar tendon while jumping during physical fitness training.  The CI underwent surgical repair the same day followed by an extensive course of physical therapy.  Magnetic Resonance Imaging (MRI) on 5 January 2004 revealed a small joint effusion with mild degenerative changes of the patella.  Despite prolonged physical therapy, there was not sufficient improvement to allow unrestricted duty.  

The 22 January 2004 MEB NARSUM noted the CI continued to have right knee pain in the morning that subsided during the day.  His pain was aggravated by any impact exercising such as jumping or running.  He reported clicking, popping and occasional giving way (2-3 times per week).  He also reported easy fatigability stating that his leg was tired with walking 25 minutes.  Physical examination noted a slightly antalgic gait.  He had full range of motion (ROM) of his right knee.  There was significant atrophy of the quadriceps with measurements of 38 cm on the right left compared with 41 cm on the left.  There was no apprehension or grinding noted and strength was normal.  

At the 13 August 2004 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported a constant dull pain with a sense of weakness and stiffness and the stiffness and pain improved with walking.  The CI professed easy fatigability and lack of endurance.  There were no reports of dislocation or recurrent subluxation.  The CI reported that his right knee pain affected his activities of daily living particularly when having to stand from a squatting position.  Physical examination showed right knee flexion to 130 degrees (normal 140) limited by pain but no pain during movement.  Repetitive movements of the knee improved his pain and ROM.  The examiner also noted some quadriceps atrophy with his right thigh measuring 37 cm versus the left thigh measuring 41 cm.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded analogously 5099-5003 (degenerative arthritis), citing lack of joint instability or loss of range of motion.  The VA rated the right knee condition 10%, coded 5010-5262 (traumatic arthritis/tibia and fibula, impairment of), citing slight limitation of motion with pain.  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 functional loss as evidenced by the quadriceps disuse atrophy to support a 10% rating (based on VASRD §4.40 and §4.45).  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).  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 chronic right knee pain condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic right knee pain condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 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	
Chronic Right Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170017480, 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