RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00731
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Multichannel Transmission Systems Operator Maintainer, medically separated for “chronic pain, left knee,” with a disability rating of 10%.   

CI CONTENTION:  Conditions continue to worsen and negatively impact daily activities.  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 - 20051221	VARD - 20070201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Left Knee	5099-5003	10%	Post Left Knee Patellar Dislocation and Repair of the Medial Patellar Femoral Ligament	5260	10%	20060304	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Pain Left Knee.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a medial patellar femoral ligament repair on 26 April 2005 after a patella dislocation from falling on his knee.  Pain did not improve after the operation and there was no further surgical indication.  

The 16 November 2005 MEB NARSUM examination, 7 months after surgery and 2 months prior to separation, noted complaints of continued anterior knee pain.  Physical examination showed flexion to 135 degrees (normal 140) and extension to 0 degrees (normal).  Painful motion was not addressed.  The examiner referenced the 3 November 2005 knee X-rays that showed mild degenerative changes of the medial aspect of the joint.  During the 28 November 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported left knee swelling and giving away while walking.  He had constant pain and the knee felt weak.  Physical examination revealed tenderness over the anterior knee with marked atrophy of one of the quadriceps muscles.  

At the 4 March 2006 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported pain with prolonged sitting or with going up or down stairs.  Physical examination showed flexion to 125 degrees and extension to 0 degrees, without pain.  There was good quadriceps function but the examiner did note a 1 cm difference in the circumference of the thigh, with the left showing atrophy compared with the right.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded analogously to 5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing leg flexion limited to 45 degrees.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) or 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).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was not applicable in this case.  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 X-ray evidence of arthritis of a major joint to support a 10% rating under code 5003.  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 20170216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007709, 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