RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01575
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Human Resource Management Specialist, medically separated for “chronic right knee pain” with a disability rating of 0%.

CI CONTENTION:  Evidence supports a higher rating.  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 that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20040817	VARD - 20050930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Right Knee Retropatellar Pain Syndrome	5024-5257	NSC	STR	
	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:

Chronic Right Knee Pain.  According to the service treatment record (STR), the CI’s right knee pain began in April 2003 when her knee locked up while running.  X-rays and MRI revealed a normal knee (ligaments, menisci, cartilage).  A 4 May 2004 primary care examination, 6 months prior to separation, revealed increased patella pain with activity and passive motion.  

The 8 July 2004 Medical Evaluation (MEB) narrative summary (NARSUM), 4 months prior to separation, noted CI complaints of chronic knee pain.  Physical examination showed a normal gait.  There was positive patella grind and crepitus, but no instability.  Range of motion (ROM) was flexion from 0- 140 degrees (normal); painful motion was not addressed.

A 6 August 2004 physical therapy examination, 3 months prior to separation, showed positive patella grind; instability and meniscus testing were negative.  ROM was flexion to 135 degrees and extension to (hyper) +3 degrees; painful motion was not addressed.  There was no VA examination proximate to separation in evidence.

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 the US Army Physical Disability Agency pain policy and moderate/intermittent pain.  The VA did not service-connect the right knee condition, analogously coded 5024-5257 (tenosynovitis-knee, other impairment), citing cancellation of the orthopedic examination.  Upon deliberation, members noted there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  Evidence supporting a compensable rating based on §4.59, §4.40 and §4.45 was not sufficiently documented.  While the primary care provider, 6 months before separation, implied there pain during knee motion, examinations more proximate to separation were silent regarding painful motion.  There was no report of loss of ROM, decrease in motor strength, speed, coordination or endurance; and with the exception of pain, there was no pathological finding.  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).  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 chronic right knee pain 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 20161013, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180001842, 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