RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00237
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Multiple Launch Rocket System Crewmember, medically separated for “chronic subjective [left] knee pain,” with a disability rating of 10%.   

CI CONTENTION:  Review requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 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.  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 - 20041119	VARD - 20050110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Left Knee Pain	5099-5003	10%	Patellar Tendonitis, Left Knee	5260	10%	20041120	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee condition began in October 2003 while running and falling into a pothole.  Radiographic imaging from November 2004 showed a normal knee, and surgery was not indicated.  The 21 October 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of pain and swelling, particularly with running and daily work activities which required climbing on, traversing and climbing off vehicles.  Physical examination showed tenderness but no edema, ecchymosis or erythema.  McMurray's testing was positive to pain only, and patellar inhibition apprehension, J-sign (indicating a lateral tracking patella), and patellar grind tests were also positive.  Range of motion (ROM) measurements recorded flexion of 110 degrees (normal 140) and extension of 0 degrees (normal).  Objective evidence of painful motion was not recorded.  During the 26 October 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported persistent left knee pain with swelling, locking and giving out.  Physical examination revealed a positive patellar grind.  There was no effusion or joint line tenderness.  

At the 20 November 2004 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported recurrent dull aching left knee pain.  Physical examination showed normal general knee appearance with flexion to 140 degrees and extension to 0 degrees.   The ROM was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded as 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also rated the left knee condition 10%, coded 5260 (limitation of flexion), based on the STR, citing chronic pain on motion as evidenced by medical records and the PEB.  Members noted there was no limitation of flexion or extension which supported a rating under the diagnostic codes 5260 or 5261.  However, there was evidence of pain with use and functional loss supporting a 10% rating (based on §4.40 and §4.45). The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  After due deliberation, considering all 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 left knee condition.  

BOARD FINDINGS:  In the matter of the chronic subjective left knee pain 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 20161123, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180014205, 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.