RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00530
BRANCH OF SERVICE: army 	SEPARATION DATE:  20050602

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E1, Basic Trainee, medically separated for “chronic pain, left knee, due to torn medial meniscus” with a disability rating of 10%.  

CI CONTENTION:  The VA rates his knee higher.  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 - 20050425	VARD - 20050727	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee, Due to Torn Medial Meniscus	5099-5003	10%	Medial Meniscus Tear, Left Knee	5099-5020	10%	20050407	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Left Knee Due to Torn Medial Meniscus.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in January 2005 during basic training.  Three left knee MRIs revealed a linear tear of the posterior horn of the left medial meniscus.  The CI was evaluated by orthopedics and it was determined that he would need surgical repair, with no guarantee the surgery would enable him to complete training.  The CI opted to enter the disability evaluation system and seek surgery in the VA system near his home.  At the 3 March 2005 MEB NARSUM examination, 3 months prior to separation, the CI reported “slight” constant pain with an intensity of 6-8/10.  He had pain with walking and prolonged standing.  He noted slight swelling and stated that his pain bothered him at night during sleep.  The physical examination showed a slightly antalgic gait.  There was minimal swelling and some crepitus on palpation of the left knee.   There was a positive McMurray’s sign.  His left knee range of motion (ROM) was flexion to 85 degrees (140 normal) and extension was 0 degrees (normal).  There was pain with flexion.  The examiner noted the CI’s pain as slight and constant per the American Medical Association pain rating scale.  

At the 7 April 2005 Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported constant left knee pain.  He reported difficulty standing and walking for prolonged periods.  The condition did not cause incapacitation and the CI was not receiving any treatment for it.  Physical examination showed a normal gait.  There was no evidence of instability or meniscal pathology.  Knee ROM was 140 flexion and 0 degrees extension and ROM was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetition.  Left knee X-rays were normal.  The VA examiner stated that the effect of the condition on the CI’s usual occupation and daily activity was “none.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded analogously as 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy (AR 635-40).  The VA also rated the left knee condition 10%, coded analogously 5099-5020 (synovitis), citing painful motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There was no history of meniscal symptoms after surgery (5259) or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to warrant a 10% 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).  There was therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code.  The panel noted that the PEB’s reliance on the USAPDA pain policy was not detrimental to arriving at the highest rating and therefore no change to the PEB code is recommended.  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 chronic left knee pain condition.  

BOARD FINDINGS:  In the matter of the left 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 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004699, 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