RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  pd-2016-01329
BRANCH OF SERVICE:  army	SEPARATION DATE:  20050112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Army National Guard, E4, Wheel Vehicle Repairer, separated for “right knee pain” with a disability rating of 0%.  

CI CONTENTION:  Rating should be higher.  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 (VA), 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 - 20041201	VARD - 20061206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	0%	Right Knee Strain	5099-5024	0%	20061206	
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

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 April 2003 when he twisted the knee while road marching with his unit.  X-rays were normal and there was no surgical indication.  

At the 2 November 2004 MEB NARSUM, 2 months prior to separation, the CI reported chronic right knee pain which worsened with long walking, marching, running, squatting and climbing stairs.  He stated his pain did not improve with rest, anti-inflammatory medication, restricted activity or physical therapy.  He could not perform his duties.  Physical examination showed “full” range of motion (ROM) with no pain on flexion or extension, but he did have pain with squatting.  On the same day at physical therapy (PT), the formal right knee ROM measurements were conducted and documented ROM (after repetition) of 0-140 degrees (normal) with pain on flexion.

At the 5 June 2006 VA Compensation and Pension (C&P) evaluation, 17 months after separation, the examiner reported the CI was taking Naprosyn for his right knee pain.  Physical examination showed a normal posture and gait.  Right knee ROM was 0-140 degrees (normal).  “There was no pain in the knee.”  There was no edema, effusion, instability, weakness, tenderness, redness, heat, abnormal movement or guarding of movement.  

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 full ROM, pain with squatting, and one joint involved.  The VA rated the right knee condition 0%, coded analogously 5099-5024 (tenosynovitis) based on the C&P examination 17 months after separation, citing a non-compensable evaluation had been established as there was no objective evidence of painful or limited motion.  

The panel adjudged the NARSUM and PT examinations had the highest probative value for rating at separation.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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 the respective codes.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 right knee condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the 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	
Right Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180000799, 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 to 10% 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