RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01298
BRANCH OF SERVICE:  army	SEPARATION DATE:  20040430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “chronic left knee pain” with a disability rating of 0%.

CI CONTENTION:  Current condition supports a higher rating. Request review of conditions not identified by either the MEB or PEB.  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 - 20040305	VARD - 20040713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Residuals Fracture Left Tibia, and Left Lateral Femoral Condyle	5299-5260	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee pain condition began in December 2002 after a motor vehicle accident.  He underwent a left lateral femoral condyle (bottom of femur bone) open reduction and internal fixation and left tibial shaft (shin bone) nail fixation.  Subsequent X-rays showed surgically repaired bones in good alignment (no malunion).  Conservative treatment did not resolve the knee pain and the CI was followed by physical therapy and orthopedics from January through December 2003.  Left knee flexion measurements ranged from 110 to 80 degrees (normal 140) while extension measurements ranged from 5 to 15 degrees (normal 0); painful motion was addressed in December 2003 by orthopedics.
The 26 February 2004 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of left knee pain significantly limiting his ability to perform his military duties.  Additionally he was only able to walk short distances.  Physical examination showed significant left quadriceps atrophy, left patellar tenderness and grind, as well as lateral and medial femoral condyle tenderness.  Left knee flexion was to 100 degrees and extension to 0 degrees; painful motion was not addressed.  There was no VA examination in evidence proximate to separation. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the left knee condition 10%, analogously coded  5299-5260 (leg, limitation of flexion) based on the STR, citing additional knee pain, weakness, and atrophy.  The panel agreed there was no limitation of flexion or extension that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 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 on orthopedic and MEB NARSUM examinations most proximate to separation.  There was no evidence of meniscal cartilage removal under the 5259 code (cartilage, semilunar, removal of, symptomatic) for a 10% rating.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  There was a fracture of both femur and tibia bones to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, the panel concluded that this pain symptom was already a component of the painful motion criterion noted above and if applied again would be considered pyramiding IAW §4.14 (avoidance of pyramiding).  After due deliberation, considering of all 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 5299-5260. 

BOARD FINDINGS:  In the matter of the chronic left knee pain condition, the panel unanimously recommends a disability rating of 10%, coded 5299-5260 IAW VASRD §4.59.  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	
Left Knee Chronic Pain	5299-5260	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161003, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170019695, 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