RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00254
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Carpentry and Masonry Specialist, medically separated for “left knee pain” with a disability rating of 0%.  

CI CONTENTION:  His left knee and right shoulder conditions have worsened.  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 - 20040429	VARD - 20050927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Left Knee Medial Meniscal Tear	5260-5010	10%	20050714	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in January 2004 after a direct blow against a foot locker.  An MRI revealed significant degenerative changes, total loss of the retropatellar cartilage and a medial meniscal tear.  

The 20 February 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of left knee pain.  Physical examination showed tenderness over the left medial femoral condyle without effusion, joint line tenderness or ligamentous instability.  The goniometric range of motion (ROM) evaluation showed flexion of 110 degrees (normal 140) and extension of 10 degrees (normal 0) with patellar grinding.  A CT scan revealed no osteochondral defect or bony lesion.  

At the 14 July 2005 VA Compensation and Pension (C&P) examination, 13 months after separation, the CI reported left knee pain rated at 3-9/10.  Physical examination showed mild patellar swelling and crepitus, and ROM, following repetitive movement, was flexion of 120 degrees and extension of 5 degrees, with pain.  Provocative testing for ligamentous instability and meniscal pathology was negative.  Strength was normal and equal bilaterally in the lower extremities, and there were no focal, motor or sensory deficits noted.  

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 slight and occasional pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the left knee condition 10%, coded 5260-5010 (limitation of leg flexion due to traumatic arthritis), based on the C&P examination, citing painful or limited motion of a major joint.  Members agreed there the 10 degrees of limited extension recorded at the NARSUM examination supported a 10% rating under code 5261 (leg, limitation of extension).  There was also documentation of pain with use, X-ray evidence of significant degenerative arthritis with total loss of the cartilage behind the patella, and objective findings of non-compensable limitation of motion with intermittent painful motion, tenderness or crepitus, supporting a 10% rating for functional loss (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); 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 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 5261.

BOARD FINDINGS:  In the matter of the left knee pain, the panel recommends a disability rating of 10%, coded 5261 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	
Left Knee Pain 	5261	10%	

AR20180014206, 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.