RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-01446
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040419

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Wheeled Vehicle Repairer, medically separated for “chronic pain left knee” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040115	VARD - 20041007	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5003	10%	Degenerative Joint Disease, Left Knee, S/P Arthroscopy	5299-5262	10%	20040908	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI’s left knee condition began during basic training in 1981 without specific injury or trauma.  The CI reinjured his left knee in 2000 and required surgical intervention.  The CI subsequently underwent two arthroscopic surgeries in December 2000 and March 2001.  A third arthroscopic and debridement procedure was done in July 2002.  Imaging studies of the left knee revealed extensive degenerative joint disease (DJD), severe osteoarthritis and a thin anterior cruciate ligament.  The 2 December 2003 MEB NARSUM examination, 5 months prior to separation, noted complaints of swelling and discomfort with left knee.  The physical examination showed left knee with crepitus, pain, swelling and DJD.  At a 30 January 2004 Orthopedic examination, 2 days prior to separation, the CI reported persistent knee pain.  Physical examination showed an antalgic gait with use of a cane.  The left knee range of motion (ROM) flexion was 120 degrees (normal 140) and extension was 10 degrees (normal 0).  The examiner concluded that the CI had end stage DJD as was likely require a total knee replacement in the not too distant future.  At the 8 September 2004 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported prior injuries and surgical procedures to his left knee.  He continued to complain of chronic pain and swelling of the knee.  The physical examination showed the CI walking with a noticeable gait with a left limp.  The ROM was 125 degrees of flexion and 10 degrees of extension.  There was no swelling but some enlargement of the knee.  There was no tenderness to palpation and no evidence of instability.  The examiner noted that the CI was using a cane.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (degenerative arthritis), citing osteoarthritis of all compartments.  The VA rated the left knee condition 10%, analogously coded 5299-5262, (tibia and fibula impairment), based on the C&P examination 7 months after separation, citing a flexion of 125 degrees.  There was an extension limitation of motion limited to 10 degrees which supported a rating of 10% under the diagnostic code 5261 (leg, limitation of extension of).  There was no limitation of motion which supported a rating under the diagnostic code for limitation of flexion (5260).  The examinations proximate to separation did not demonstrate the presence of recurrent subluxation or lateral instability (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  There was no ankylosis of the knee to justify a rating (5256).  There was a history of meniscal removal, 5259 (cartilage, semilunar, removal of, symptomatic) supporting a 10% rating as adjudicated by the PEB, however it is not a separate condition which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  There is no benefit to the CI to change the VASRD coding and therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.  

BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161012, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180003422, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
Enclosure