RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00169
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050506

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Chemical, Biological, Radiological, Nuclear Specialist, medically separated “chronic left knee pain” with a disability rating of 10%.  

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 - 20050223	VARD - 20050623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Chondromalacia Patella, Left Knee	5261	0%	20050616	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in May 1998 during basic training without specific trauma.  Knee X-rays and MRI were negative, and conservative treatment did not alleviate the knee symptoms.  A physical therapy (PT) evaluation on 17 June 2004noted a normal gait, tenderness of the pes anserine bursa area (under tendons of muscles medial and inferior to the knee), and a positive patellar grind test.  There was pain with resisted strength testing as well as squatting, but full knee range of motion (ROM).  

The 17 September 2004 MEB NARSUM examination, 8 months before separation, noted CI complaints of left knee pain with prolonged standing, stooping, squatting, kneeling and bending.  Physical examination showed knee ROM from 0-120 degrees (normal 0-140); painful motion was not addressed.  A PT ROM study the same day showed, after repetition, 3 degrees of hyperextension and 145 degrees of flexion.  During the 7 October 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported extreme pain and swelling with prolonged knee use, and the provider noted left knee pain with passive ROM.

At a primary care visit on 14 April 2005, 1 month before separation, the CI reported left knee pain and a diagnosis of retropatellar pain syndrome for 6 years.  She experienced pain with active movement of the knee, but denied swelling, locking, or instability.  Physical examination noted decreased active flexion and extension with patellar crepitus.  

At the 16 June 2005 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI described constant left knee pain, rated at 3/10, and swelling that increased with prolonged walking or climbing stairs; she also wore a knee brace daily.  Physical examination showed left knee tenderness at the pes anserine bursa, but no swelling or effusion.  Knee ROM was 0-110 degrees, without painful motion, but there was crepitus with both extension and flexion; there was no additional loss of ROM with repetitive use.  Left knee X-rays were negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing no ligamentous instability or joint laxity, full ROM and normal radiographic studies.  The VA also rated the left knee condition 0%, coded 5261 (limitation of leg extension), based on the C&P examination, citing non-compensable limitation of motion without painful motion.  Members agreed that there was no limitation of flexion or extension which attained a 10% rating under codes 5260 or 5261.  However, there was evidence of painful motion with functional loss supported by decreased ROM and crepitus at the primary care and VA examinations which supported a 10% rating based on §4.59, §4.40 and §4.45.  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); and 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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the knee condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the chronic left knee pain, the panel recommends a disability rating of 10%, coded 5099-5003 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	
Chronic Left Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160923, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180013028, 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