RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01260
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Guard E4, Light Wheel Vehicle Mechanic, medically separated for “chronic right knee pain” with a disability rating of 10%.  

CI CONTENTION:  Received a higher rating for his right knee and PTSD conditions from the VA.  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 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 - 20040402	VARD - 20050110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Right Meniscus Tear with Degenerative Joint Disease	5260	10%	20041109	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in February 2003 after he jumped off of a truck twisting his knee.  During the primary care clinic appointment on 12 September 2003 the CI reported having a knee problem since 1991 after a football injury.  The CI complained of 4/10 knee pain with instability.  Physical examination showed effusion, no tenderness and “full” range of motion (ROM).  X-rays in September 2003 were normal.  

At the 24 September 2003 MEB NARSUM, 10 months prior to separation, the CI reported right knee pain.  The examiner noted the CI’s condition was related to a tear in the posterior horn of the lateral meniscus; the CI declined surgical treatment.  Physical examination showed no effusion and a stable knee.  Bilateral ROM was flexion to 135 degrees (normal 140) and extension was 0 degrees (normal).  Lachman (laxity) and McMurray (meniscal) tests were negative.  There was mild tenderness along the posteromedial joint line.  An MRI showed a tear in the posterior horn of the lateral meniscus.  

During the 9 November 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported “an injury to his right knee where he twisted it when he jumped off the back of a truck and tore a meniscus.”  The CI described intermittent 8/10 right knee pain that worsened with cold-rainy weather.  Physical examination showed the CI had a minimal intermittent limp.  There was no tenderness, warmth or erythema (red skin due to increased blood flow).  The right knee was stable.  Repetitive ROM was flexion to 110 degrees and extension was 0 degrees; painful motion was present and the CI was able to tandem walk.  X-ray studies showed mild narrowing of the medial joint compartment, suggestive of early degenerative changes of the right knee.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5003 (arthritis, degenerative), citing no loss of joint motion or evidence of joint instability.  The VA rated the right knee condition 10%, coded 5260 (leg, limitation of flexion), citing additional functional loss due to pain following repetitive use.  

The panel agreed 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).  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).  Analogous meniscal coding was considered; however, there was no history of surgery to remove a meniscus (5259), and although the CI had a torn meniscus, there was insufficient evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  There was therefore no VASRD §4.71a rating higher than the 10% under any applicable code.  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 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 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 20160927, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180000481, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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