RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00720
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Healthcare Specialist Trainee, medically separated for “chronic left knee strain” with a disability rating of 0%.   

CI CONTENTION:  The CI made no specific contention.  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 - 20091014	VARD - 20091112	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Strain	5260	0%	Left Knee Strain	5260	0%	20090709	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Chronic Left Knee Strain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in November 2008 when he sprained his left knee during a run.  An MRI showed no evidence of vascular abnormalities or meniscus tearing.  There was moderate swelling of the soft tissues and a signal increase within the posterior horn of the medial meniscus without a linear tear.  At an orthopedic clinic examination in December 2008, the CI’s range of motion (ROM) was 0 to 135 degrees (normal 0 to 140).  Gait was normal and there was no crepitus, laxity, patellar instability or locking.  Provocative testing to elicit meniscal pathology was negative, but there was trace effusion and joint line tenderness.  The examiner noted the CI’s pain was improving and he felt the CI did not have a torn meniscus.  The 10 June 2009 MEB NARSUM, 5 months prior to separation, noted complaints of mild pain, with no stiffness.  There was no giving-way, locking, fatigability or lack of endurance.  The physical examination was conducted by the VA on 9 July 2009 (see below).  

The VA Compensation and Pension (C&P) evaluation, 4 months before separation, revealed no swelling, redness, tenderness, weakness, instability, deformity or crepitation (grinding sensation).  Left knee ROM, following repetitive movement, was 0-115 degrees (normal 0-140).  No objective pain was reported.  Neither laxity nor meniscal findings were addressed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5260 (leg, limitation of flexion of), citing the C&P examination and rating decision.  The VA rated the left knee condition 0%, coded 5260, based on the C&P examination, citing absence of painful or limited motion.  

There was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 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).  There was no evidence of painful motion with functional loss supporting a 10% rating (based on VASRD §4.59, §4.40 and §4.45).  Therefore, the panel concluded there was not sufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  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 left knee 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 20160221, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004791, 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