RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01404
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040516

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, 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 (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 - 20040315	VARD - 20040804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	0%	Status Post Bursectomy, Right Knee	5260	0%	20040624	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in approximately August 2002 with no obvious etiology elicited, however the CI believed it began after a parachute jump.  The CI noticed pain with squatting, climbing stairs and after running.  He first sought treatment in December 2002.  The 18 December 2002 X-ray was noted to be normal.  An MRI on 9 June 2003 was also normal.  He was diagnosed with pre-patellar bursitis.  The CI underwent a right knee bursectomy on 8 October 2003, but continued to have pain.  At the Orthopedic post-op follow-up on 22 October 2003, the range of motion (ROM) was approximately 60 degrees flexion (140 normal) and full extension.  The CI was not bending his knee due to pain.  At the 5 January 2004 Orthopedic clinic appointment there was mild tenderness over the anterior patella, pain with loading of the kneecap, no abnormal patellar mobility and full ROM.
The 3 February 2004 MEB NARSUM examination, 3 months prior to separation, noted continued complaints of knee pain despite surgery.  Physical examination showed no edema or erythema, full ROM, mild tenderness over the anterior patella, pain with loading on the knee cap, no abnormal patellar mobility and negative Lachman’s and McMurray.  

At the 24 June 2004 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported continued pain rated 2/10 since the surgery, however the pain would increase to 8/10 with kneeling, going down stairs, or running.  Physical examination showed no heat, warmth, tenderness to palpation or edema.  ROM was flexion of 130 degrees (140 normal) and extension of 0 degrees (0 normal).  There was pain with extension.  Repetitive motion did not cause an increase in discomfort.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (arthritis, degenerative), citing full range of motion without joint instability and application of the US Army Physical Disability Agency pain policy.  The VA also rated the right knee condition 0%, coded 5260, (leg, limitation of flexion) based on the C&P examination 1 month after 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 or evidence 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 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 right knee condition, coded 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 §4.59.   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	
Right Knee Pain	5099=5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161002, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180000802, 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