RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX  	CASE:  PD-2016-00775
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041029

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

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 - 20040916	VARD - 20050504	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain…	5099-5003	0%	Chondromalacia, Medial Femoral Condyle, Right Knee	5299-5014	10%	20050413	
Hypertonia	Not Unfitting	No VA Exam in Evidence	
Low Back Pain	Not Unfitting 		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in January 1996 without any specific injury.  He reinjured his right knee on 5 November 2001 while running during physical training.  An MRI revealed a possible meniscal tear.  He underwent arthroscopy on 20 December 2001 which revealed grade III chondromalacia of the medial patellar facet.  Articular cartilage was removed.  A second MRI in April 2003 revealed a medial meniscal tear and continued chondromalacia of the patella.  This led to a second arthroscopy on 21 April 2003 in which he underwent a partial medial meniscectomy for medial meniscal tear and chondroplasty of his medial femoral condyle secondary to a chondral injury.  Since this second surgery, he has had continuous pain, swelling and an inability to stand for prolonged periods or run.  

At the 17 August 2004 MEB NARSUM, 2 months prior to separation, the CI reported that he had continuous pain in his right knee with episodes of giving way when standing for prolonged periods as well as locking when sleeping.  His pain was exacerbated by increased physical activity and physical therapy had not alleviated the symptoms.  He was unable to run, jump, ruck, march or move with a fighting load at least 2 miles.  Physical examination showed a range of motion (ROM) at 0 degrees (normal) of extension and 125 degrees (normal 140) of flexion on his right knee.  His knee was stable to varus and valgus testing.  He had negative Lachman’s and anterior drawer tests (instability).  He did have tenderness to palpation along the medial condyle while his knee was held in a flexed position.  Radiographs of his knee after his last surgical procedure revealed no change in his joint space and clinical findings were consistent with his physical examination.  His final diagnosis was chronic right knee pain secondary to chondromalacia patellae and medial femoral condyle chondral injury, which was not responsive to surgery.  

At the 13 April 2005 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported continued chronic right knee pain.  He reported that he had been using a cane when ambulating since October 2004 to help stabilize his right knee.  He reported constant pain on the medial aspect that worsened with weight-bearing, 10-15 minutes of standing or 60 minutes of walking.  Cold exposure also increased his pain.  Squatting and kneeling caused immediate pain.  He reported he had locking of the knee occurring approximately once every 4-5 days that only lasted for moments.  He stated his right knee would give way several times per day.  He also reported daily swelling that worsened as the day progressed.  He also reported having used a knee brace since August 2004 to help stabilize the right knee.  Heat and ice and staying off of his knee helped to alleviate his pain.  He reported that he did not have any flare-ups.  He stated that his right knee did not currently affect his usual occupation.  Physical examination showed no point tenderness to palpation and no effusion of his right knee.  His knee was stable when stressed in an anterior-posterior, varus and valgus manner.  His right knee ROM, after repetition, was 109 degrees of flexion and 0 degrees extension with pain at the end range of flexion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded analogously as 5099-5003 (degenerative arthritis), citing no significant loss of joint motion.  The VA rated the right knee condition 10%, coded analogously as 5299-5014 (osteomalacia), citing painful, limited motion.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258.)  There was no fracture, nonunion or mal union 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 a history of surgery to remove a meniscus (5259) to support a rating under that code.  The CI remained symptomatic with persistent pain, swelling, giving way and locking.  He was using a cane to stabilize the knee.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a 10% rating for the right knee condition; proposing code 5259 for its clinical specificity.

Contended PEB Conditions:  Hypertonia and Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions 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 either of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic right knee condition, the panel unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  In the matter of the contended hypertonia and low back pain conditions, the panel unanimously recommends no change from the PEB determinations 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	
Chronic Right Knee Pain	5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170017932, 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