RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00482
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E3, Bradley Fighting Vehicle System Maintainer, medically separated for “chronic left knee pain” with a disability rating of 0%.  

CI CONTENTION:  “Because it pains me every day and limits my ability to provide for my family…”  The CI 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 - 20050202	VARD - 20050822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Residuals of Patella Fracture, Left Knee	5261-5010	10%	20050527	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

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 1999 after falling and fracturing his left patella.  The fracture was healing and the CI separated from the military in November 1999.  In November 2003, the knee pain returned when the CI was mobilized and in training.  Six months into the deployment, the left knee began to hurt to the point that the CI was medically evacuated and diagnosed with retropatellar pain syndrome.  The 7 April 2004 clinic evaluation showed limited range of motion (ROM) and left knee hyperextension.  At the 14 July 2004 primary care clinic evaluation, the examiner recorded a normal gait with a slightly painful ROM.  During the 19 August 2004 orthopedic examination, 6 months prior to separation, the CI reported intermittent left knee pain with prolonged sitting or standing and walking up stairs.  Physical examination revealed no left knee tenderness with good patellar mobility.  ROM showed flexion of 145 degrees (normal 140) and extension of 0 degrees (normal), limited by pain.  Patellar compression test was positive.  Provocative testing for ligamentous instability or meniscal pathology was negative.  Knee strength, reflexes, and sensation were normal.  Imaging revealed evidence of a previous fracture in the anterior aspect of the patella, but was otherwise normal.  

The 3 December 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of left knee pain.  Physical examination showed full ROM.  There was no tenderness around the knee joint line or patella and good patellar mobility.  The patellar compression test was positive for pain.  Provocative testing for ligamentous instability or meniscal pathology was negative.  He had no medial or lateral joint line tenderness.  Strength and reflexes were normal.  

The 27 May 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, noted complaints of locking of the left knee with sharp pain after repetitive flexion.  Discomfort was experienced with activities such as crawling, kneeling, or squatting.  The examiner recorded a normal gait.  There was no edema, tenderness, crepitus, effusion, or instability.  ROM showed flexion of 140 degrees and extension of 0 degrees.  Repetitive ROM did not cause discomfort nor was the ROM decreased.  ROM was not limited by pain, fatigue, weakness, or lack of endurance.  There was discomfort and audible crepitus noted when the CI was asked to squat.  Provocative testing for ligamentous instability or meniscal pathology was negative.  Motor, reflex, and sensory examinations were normal.  

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 (arthritis, degenerative), citing degenerative joint disease with normal radiographs and motion.  The VA rated the left knee condition 10%, analogously coded 5099-5010 (traumatic arthritis), based on the C&P examination, citing pain on 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).  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), to support a rating under those codes.  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 VASRD §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 majority recommends a disability rating of 10% for the left knee condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel majority recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  The single voter for dissent recommends no change and did not elect to submit a minority opinion.  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 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007160, 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