RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01633
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040427

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

CI CONTENTION:  “Secondary injuries are being denied and causing more pain than prior injuries.”  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 - 20040324	VARD - 20041217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5261	0%	Chronic Capsulitis Right Knee 	5299-5259	0%	20040623	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee pain condition began in June 2003 while performing physical training when he developed sudden pain, swelling, and locking of his right knee during advanced training (AIT).  A similar episode was reported during basic training.  No trauma or injury was reported.  X-rays on 9 June 2003 revealed a large osteochondral defect, subchondral fracture of the medial femoral condyle, and a sclerotic (thickened) rimmed lucency within the medial femur, probably a benign non-ossifying fibroma.  An MRI on 10 June 2003 revealed a focus of osteochondritis dissecans in the medial femoral condyle with no apparent displacement and a radial, horizontally oriented, tear of the medial meniscus.  On 9 July 2003, the CI underwent an arthroscopic debridement of the osteochondral defect of the medial femoral condyle and drill holes were made in the area to encourage regrowth of the joint surface.  The medial meniscus tear was then debrided.  However, his pain continued despite physical therapy, nonsteroidal anti-inflammatory drugs, and limitation of duties.  

The 16 March 2004 MEB NARSUM examination, 1 month prior to separation, noted the complaint of pain with prolonged walking, which limited his ability to walk more than one mile.  Physical examination showed a mildly antalgic gait, a mild effusion, and range of motion (ROM) at +5 degrees (normal 0) to 115 degrees (normal 140).  Painful motion was not mentioned.  McMurray’s test (to determine a meniscal tear) and stability tests (drawer, Lachman’s, and pivot) were negative, and there was no varus or valgus laxity noted nor was any joint line tenderness present.  Additionally, the patellofemoral compression test (to determine articular deterioration) was negative. 

At the 7 July 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported right knee pain with decreased ROM.  Physical examination of the right knee showed no instability or fluid in the joint, and there was no pain with patellar grinding or tenderness.  ROM measurements were 140 degrees flexion and 0 degrees extension.  Repeat motion caused no increase in pain or decrease in ROM of either knee.  X-rays of both knees on 7 July 2004 were negative and an X-ray of the right knee, ordered for an injury at work, was within normal limits with no bony or soft tissue pathology on 12 August 2004.  X-rays of the right knee on 12 November 2004 showed an osteochondral defect in the medial femoral condyle was less well seen suggesting interval healing.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition 0%, coded 5261 (leg, limitation of extension of), citing ROM at 5-115 degrees and no joint laxity.  The VA also rated the chronic capsulitis right knee condition 0%, analogously coded 5299-5259 (cartilage, semilunar, removal of symptomatic), based on the C&P examination, citing ROM at 140 degrees flexion, no joint instability, no pain on patellar grinding, and no increase or decrease pain with motion.  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) to support a rating under that code.  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).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case, and provides a route to a 10% rating.  After due deliberation, considering all 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 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 the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain	5259	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161026, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180014196 , 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