RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01659
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040813

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 “chronic left knee pain due to patellar tendinitis” with a disability rating of 0%.  

CI CONTENTION:  He currently has a 60% rating (presumably VA) but would like to be re-rated and has ongoing neck problems, a pinched nerve, numb left fingers, lower back pain, and diabetes.  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 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.  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 - 20040722	VARD - 20050107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain Due to Patellar Tendinitis	5024	0%	Patellar Tendonitis, Left, Postoperative, Tendon Removal and Debridement	5099-5024	10%	20041103	
			Left Knee Laxity	5257	10%	20041103	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain due to Patellar Tendinitis.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in August 2002 for chronic tendinitis of the patellar tendon.  After recovery and therapy he returned to duty and deployed to Iraq for 5 months in 2003, where his pain got progressively worse due to walking on uneven terrain.  He was unable to return to duty as an infantryman and after meeting a Medical Retention Board, he was recommend for reclassification.  However, he could not complete training in an alternate specialty, and was subsequently referred for MEB.  

The 21 June 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of left knee pain causing difficulty walking, standing or sitting for prolonged periods, and carrying more than 5-10 pounds.  The CI claimed occasional popping and clicking, but denied locking or giving way.  On examination, the left knee range of motion (ROM) was flexion of 125 degrees (normal 140) and extension of 0 degrees (normal) and was equal to the unaffected side.  The knee was tender to palpation about the anterior medial joint line as well as directly over the patellar tendon.  There was no mention of painful motion.  Tenderness to palpation was also noted on the 23 June 2004 MEB examination (recorded on DD Form 2808) conducted 2 days later, which also reported positive patellar grind.  

At the 3 November 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI complained daily pain in both knees, lasting a few hours and sometimes all day, and exacerbated by prolonged standing or walking.  He reported periodic buckling of both knees.  Physical examination showed left knee flexion limited to 130 degrees and hyperextension to -4 degrees, both with painful motion.  After 5 repetitions the extension was decreased to 90 degrees and hyperextension to -1 degree.  The examiner reported a laxity of 1+ (which was equal with the unaffected side).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5024 (tenosynovitis), citing no joint instability and full ROM.  The VA rated the left knee condition 10%, coded analogously as 5024 (tenosynovitis), based on the C&P examination 3 months after separation, citing painful motion.  The VA also provided a 10% rating, coded 5257 (knee impairment, other), citing the 1+ laxity reported on the C&P examination which showed a slight, recurrent subluxation or lateral instability.  There was no limitation of flexion or extension that supported a rating under the VASRD 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) 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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) documented on the C&P examination.  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 left knee condition, coded 5024.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel unanimously recommends a disability rating of 10%, coded 5024 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	
Chronic Left Knee Pain due to Patellar Tendinitis	5024	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161024, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180002378, 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