RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  pd-2016-01410
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040406

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 “right knee pain” with a disability rating of 0%.  

CI CONTENTION:  “Please 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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20040308	VARD - 20050607	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	0%	Right Knee Injury	5259	10%	20050209	
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

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 December 2001 in a twisting injury while deployed to Kosovo.  He re-injured the knee during a road march in July 2002 with a second twisting injury. An MRI showed a remotely torn anterior cruciate ligament (ACL) as well as an oblique tear to his medical meniscus of the right knee.  He underwent arthroscopic knee surgery and debridement of the medial meniscus tear in June 2004.  He continued with physical therapy, profiling and medication without significant success. He was able to deploy to Afghanistan but continued to have swelling, pain and instability and was returned to his home station.  

At the 3 February 2004 MEB NARSUM, 2 months prior to separation, the CI reported right knee pain that made him unable to perform the duties of an Infantryman or the standard Army Physical Fitness Test.  He reported that standing for prolonged periods of time increased his pain to 7/10. The NARSUM referenced his history and physical examination conducted on 17 October 2003 noting full right knee range of motion (ROM) (normal 140 degrees) without pain, and pain in his lateral right knee with medial stressing. There was no effusion or evidence of knee instability.  

During a 9 February 2005 VA Compensation and Pension (C&P) evaluation, performed 10 months after separation, the examiner noted quadriceps strength as normal and equal bilaterally and knee flexion and extension against resistance as normal and equal bilaterally.  The CI was able to rise on his toes and heels without difficulty and there was no redness, warmth or effusion.  ROM of the right knee was 120 degrees of flexion.  There was no pain during ROM measurements and no pain, discomfort or fatigability noted with repetition and no evidence of instability. The final diagnosis was “right knee medial meniscal and ACL repair, June 2003, without any instability.”  

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 5259 (cartilage, semilunar, removal of, symptomatic), citing “symptomatic removal of the semilunar cartilage.”  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  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).  There was no evidence of painful motion with functional loss to support a rating based on §4.59, §4.40 and §4.45.  However, there was a history of surgery to remove a meniscus (5259) to support a rating under the code 5259 at 10%.   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 pain condition, coded 5259.  

BOARD FINDINGS:  In the matter of the right knee pain condition, the panel unanimously recommends a disability rating of 10%, coded 5259 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	5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161006, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 
AR20180000803, 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