RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01707
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040809

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Petroleum Supply Specialist, medically separated for “left knee pain” with a disability rating of 0%.  

CI CONTENTION:  “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 that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040615	VARD - 20050404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Degenerative Changes Post-Operative Left Knee Injury	5010	10%	20041116	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his left knee in August 2002 while playing basketball.  Conservative management, including limited duty, medications, and rehabilitation, was unsuccessful.  In August 2003 the CI underwent surgical repair of the anterior cruciate ligament, medial meniscus repair, and repair of the medial femur at the knee.  Despite surgery and physical therapy, the pain persisted and the CI was unable to return to full duty.  

At the 30 January 2004 orthopedic consult to the MEB, there was minimal effusion and the range of motion (ROM) showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal).  There was a 1-A Lachman but no gross valgus laxity.  Quadriceps tone was good.  
At the 12 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported his knee locked if he sat for a period of time and his knee gave out when walking for a while.  The physical examination showed tenderness at the medial anterior joint line with mild effusion.  There was a positive Lachman’s and anterior drawer on testing but with a good endpoint.  The 12 April 2004 MEB NARSUM examination noted complaints of continued knee pain despite surgery and therapy.  The physical examination showed mild tenderness about the medial anterior joint line and minimal tenderness over the lateral joint line.  Mild effusion was noted.  The examiner referred to the ROM examination completed by physical therapy on 30 January 2004 which showed left knee flexion at 130 degrees and extension at 0 degrees.  Painful motion was not reported.

At the 16 November 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported his he was unable to perform physical activities because the knee became painful and would give out.  Physical examination showed a normal gait.  The ROM was flexion of 120 degrees and extension of 0 degrees with pain on flexion.  The ROM of the right knee was normal as was the gait.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing arthritis of one major joint.  The VA rated the left knee condition 10%, coded 5010, (arthritis due to trauma), based on the C&P examination 3 months after separation, citing reduced painful 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, respectively).  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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 5260.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel unanimously recommends a disability rating of 10%, coded 5260 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Pain	5260	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161104, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180002674, 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