RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01518
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Multichannel Transmission System Operator/Maintainer, medically separated for “chronic pain, right knee” 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(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, 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 it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20040701	VARD - 20041020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	0%	Knee Strain S/P Operative	5099-5024	10%	20040429	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right Knee.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a diagnostic arthroscopy in October 2003 for a suspected medial meniscal tear, but there was no meniscal deficit. 

The 17 February 2004 MEB orthopedic examination, 7 months prior to separation, noted complaints of persistent right knee pain.  The examiner recorded the CI was unable to run because of pain and swelling.  Physical examination showed a normal gait and ability to rise from a seated position.  Patella apprehension and grind tests were negative.  Range of motion (ROM) testing showed flexion of 135 degrees (normal 140) and extension of 0 degrees (normal) without painful motion.  
The 6 April 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of knee pain.  Physical examination showed patella tenderness with crepitus.  ROM was full without evidence of painful motion.  The 21 April 2004 MEB physical therapy ROM study, 5 months prior to separation, showed flexion of 130 degrees and extension of 0 degrees.  Painful motion was not addressed. 

The 29 April 2004 VA Compensation and Pension (C&P) physical examination, 5 months before separation, showed a normal gait.  McMurray test for torn meniscus was negative.  ROM testing showed flexion of 140 degrees and extension or 0 degrees.  Although there was painful motion, ROM was not limited by fatigue, weakness, lack of endurance or incoordination. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing slight and intermittent pain IAW the Army’s pain policy.  The VA rated the right knee condition 10%, analogously coded 5099-5024, (tenosynovitis), based on the C&P examination 5 months before separation, citing painful motion.

The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was not applicable in this case as no meniscal deficit was found.  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).  Panel members noted there was only one (C&P) of four pre-separation examinations that recorded painful motion.  Based on the evidence, panel members concluded there was not a preponderance of evidence to justify a 10% rating under 4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 10%, but elected not to submit a minority opinion.  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 20161018, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180001816, 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