RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00705
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081010

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Operating Room Specialist, medically separated for “right knee patellar tendonitis” with a disability rating of 10%.  

CI CONTENTION:  No specific contention made.  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 - 20080822	VARD - 20090423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Patellar Tendonitis 	5024	10%	Bursitis Right Knee w/ Surgical Scar	5019-5260	10%	20090212	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s knee condition began in 2005 during basic training.  She subsequently underwent a right knee arthroscopy with a pre-patellar bursectomy on 13 May 2008.  This did not improve her pain and additional surgery was not indicated.  

The 5 August 2008 MEB NARSUM examination, 3 months after the CI’s operation and 2 months prior to separation, noted complaints of a constant, achy, stabbing pain localized behind the right knee and around the kneecap.  It increased with running, walking or driving a vehicle.  Physical examination showed an antalgic gait and a well-healed scar.  Range of motion (ROM) showed flexion to 100 degrees (normal 145) and extension to 5 degrees (normal 0) limited by pain.  There were no further limitations due to fatigue, lack of endurance, or in-coordination.  

At the 12 February 2009 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported right knee pain.  Physical examination showed palpable suprapatellar bursitis but no knee joint swelling.  Measured ROM was flexion to 120 degrees (normal 145) with pain beyond 100 degrees and extension to 0 degrees (normal).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5024 (tenosynovitis), citing slight loss of motion.  The VA also rated the knee condition 10%, dual coded 5019-5260 (bursitis-limitation of flexion), based on the C&P examination, citing functional loss of motion due to pain.  Panel members agreed there was no limitation of motion which supported a rating under the diagnostic code for limitation of flexion (5260).  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 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 that code.  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).  The panel also noted the MEB NARSUM examination supported a 0% rating, coded 5261, for limitation of extension to 5 degrees, but that this did not constitute a rating advantage to the CI.  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 knee condition.  

BOARD FINDINGS:  In the matter of the right knee pain 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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007165, 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