RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01757
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Intelligence Analyst, medically separated for “right 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 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 - 20040205	VARD - 20040622	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5299-5278	0%	Posttraumatic Changes, Bilateral Knees	5299-5010	10%	20040301	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began during advanced individual training in April 2001 when he began having pain in the suprapatellar region with no direct trauma.  He was given nonsteroidal anti-inflammatory pain (NSAID) medication and a profile to run at his own pace and distance.  This pain continued and began to wake him at night; he noted intermittent swelling and the knee giving out going up and down stairs.  He was evaluated with a bone scan and diagnosed with a stress fracture of the proximal tibia of the right knee; there was mildly increased uptake also seen in the left tibia that was not consistent with stress fracture, but stress reaction.  He did respond somewhat to anti-inflammatory pain medication and he continued on profile.  
Over the course of the next few years, he never regained his ability to perform satisfactorily and was continuously on temporary profiles.  An MRI for chronic pain in 2003 showed the old stress fracture.  The CI had met all of his appointments, and all of the recommended dosages of his medications.  He had a commander's letter stating he was a “strong and willing to fight soldier” who had unfortunately suffered from chronic right knee pain after having a stress fracture to his right knee in the past with findings suggestive of post-traumatic stress reaction.  An orthopedics evaluation determined there was no surgical interventions that would assist him.  

During the May 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 12 months prior to separation, the CI reported constant right knee pain 3/10 which was relieved with Tylenol and immobility.  Physical examination showed full range of motion (ROM) without pain and edema or crepitus.  The anterior, posterior, lateral, and medial knee was stable.  There was negative drawer and Lachman’s testing.  The commander recommended retention in July 2003.  

The 24 November 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of knee pain.  He was able to walk and bicycle and required daily pain medications in the form of NSAIDs for breakthrough pain.  Physical examination showed full ROM of the knee without pain and no instability.  

At the 1 March 2004 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported right knee pain.  Recreation included mountain bike climbing and the gymnasium.  Physical examination showed a normal gait.  The knee was normal in outline and symmetric in form and function.  There was no effusion, heat, redness, muscle atrophy, or tenderness.  Sensory perception and deep tendon reflexes were within normal limits.  Drawer and McMurray tests were negative.  ROM was full and without restriction, pain, weakness, lack of endurance, fatigue, or incoordination.  There was no evidence of recurrent subluxation or locking pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain condition 0%, analogously coded as 5278 (claw foot (pes cavus)), which was coded in error for the right knee condition.  The VA rated the right knee pain condition 10%, analogously coded as 5010, (arthritis, due to trauma, substantiated by X-ray findings), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  

The PEB rated the right knee pain 0% yet in the disability description on the DA Form 199 referenced a foot condition which “existed prior to service” and used a foot code.  The STR, MEB NARSUM, C&P and PEB identified the disability as right knee pain, so there is a presumption that the PEB mistakenly coded a foot condition.  

Panel members agreed the analogous 5010 code was appropriate.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% 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) 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).  No additional functional limitation was evidenced by the examinations.  Therefore the panel concluded there was insufficient evidence to support a rating higher than the 0% adjudicated by the PEB, and a coding change provides no benefit to the CI.  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 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 20161122, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005708, 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