RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01395
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20041001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Human Resources Specialist, medically separated for “chronic right knee pain” with a disability rating of 0%.  

CI CONTENTION:  “During the process of the MPEB [sic], I was having issues with tingling, numbness from my back to the waist down.  It caused me to have re-occurrences of UTIs and had to be on an antibiotic, but it went un-noted that I was having these issues as a result of my injuries I sustained while on active duty.”  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 - 20040818	VARD - 20041020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	0%	Right Knee Medial Meniscus Repair	5260	10%	20040625	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

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 November 2000 while running during a physical fitness test.  She reported she heard a pop and then fell.  Radiographic studies showed no bony abnormalities.  The CI continued with conservative treatment/therapy and on 8 February 2002 underwent arthroscopy for plica syndrome of the right knee.  A small degenerative tear was found in the lateral meniscus in the posterior medical aspect of the meniscus.  The surgeon also identified a fibrous band going over the medial femoral condyle (medial plica).  

At the 9 April 2004 MEB NARSUM examination, 6 months prior to separation, the CI reported continued right knee pain, inability to do any running, push-ups or physical training.  Physical examination showed a normal gait.  Muscle strength in upper and lower extremities was 5/5.  There was no swelling or effusion and her surgical scar was well healed.  Her right knee range of motion (ROM) was 130 degrees of flexion (140 normal) and 0 degrees of extension (0 normal).  She had negative posterior and anterior drawer tests, no varus or valgus instability, an equivocal McMurray’s test and a negative patellar compression test.  There was minimal joint line tenderness and no joint effusion.  The patella was tracking well within the patellofemoral groove.  There was slightly increased sensitivity along the medial, lateral and inferior joint lines and anterior aspect of the tibia.  

During a 25 June 2004 VA Compensation and Pension (C&P) examination, 3 months prior to separation, the CI reported she had constant symptoms of popping, locking, swelling and severe pain.  She was unable to run or perform any activity that required right knee bending.  She reported no episodes of incapacitation or lost time from work due to her condition.  Physical examination showed normal posture and gait.  She did not require any assistive device for ambulation.  Her right knee ROM was normal with 140 degrees of flexion and 0 degrees of extension.  The examiner reported that the right knee range of motion was additionally limited by pain, but the examiner did not state to what degree.  ROM on the right knee was not additionally limited by fatigue, weakness, lack of endurance or in-coordination with repetition.  The drawer test was within normal limits as was the McMurray’s test.  There was crepitus and lateral joint line tenderness.  

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 the US Army Physical Disability Agency pain policy (AR 635-40).  The VA rated the right knee condition 10%, coded 5260 (limitation of leg flexion), citing limitation of motion due to pain.  There was no limitation of motion that attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  There was no history of surgery to remove a meniscus (5259) to support a rating under those codes.  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).  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 left knee condition, coded 5099-5003.  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161014, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170019490, 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