RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00745
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071025

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Automated Logistical Specialist, medically separated for “right knee pain” with a disability rating of 0%.   

CI CONTENTION:  “Soldier got a rating of 0%.”  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 - 20070816	VARD - 20080609	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5003	0%	Degenerative Joint Disease of the Right Knee	5003-5024	10%	20080418	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee meniscal surgery in October 2004.  At the 29 September 2005 VA Compensation and Pension (C&P) evaluation, the CI reported pain when going up and down stairs, driving or standing for long periods of time.  He also complained of swelling with walking and was unable to run.  Physical examination showed a normal appearing right knee with no evidence of ankyloses, instability, subluxation, locking pains, joint effusion, crepitus or meniscal pathology.  Right knee range of motion (ROM) showed flexion of 130 degrees (normal 140) with pain at 120 degrees and extension of 0 degrees (normal).  The examiner noted that ROM was limited by pain, fatigue and lack of endurance with repetitive motion, with pain having the major impact.  Right knee X-rays showed osteoarthritic changes.
At the 17 May 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, there was no evidence of instability, but there was patellar apprehension with crepitus in the right knee.  The CI was able to heel and toe walk, but was unable to squat or duck walk secondary to pain.  The 17 May 2007 MEB NARSUM examination was completed by the same examiner on the same day as the MEB examination above.  The CI reported complaints of 7/10 pain with activity, which worsened with climbing stairs or kneeling.  Physical examination was as documented for the MEB examination above.  The 22 May 2007 physical therapy ROM study showed right knee flexion of 116 degrees and extension of 0 degrees, limited by pain.  

The 14 April 2008 VA Compensation and Pension (C&P) evaluation, 7 months after separation, showed tenderness, but no edema, effusion, weakness, redness, heat, guarding of movement,  subluxation, locking pain, crepitus, meniscal pathology or instability.  Right knee ROM was flexion of 140 degrees and extension of 0 degrees.  The joint function was limited by 10 degrees following repetitive use due to pain, fatigue, weakness and lack of endurance, with pain having the major functional impact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5003 (arthritis, degenerative), citing no instability and ROM limited by pain.  The VA rated the right knee condition 10%, coded 5003-5024 (arthritis, degenerative - tenosynovitis), based on the C&P examination 7 months after separation, citing functional loss caused by pain and painful or limited 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 osteoarthritis on X-rays with painful limited motion warranting a 10% rating under 5003.  There was also painful motion with functional loss supporting a 10% rating coded 5299-5260 (based on §4.59, §4.40 and §4.45).  The persistence of pain after meniscal surgery alternatively warranted a 10% rating in this case under the 5259 code (cartilage, semilunar, removal of symptomatic).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257) and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a higher rating under the respective codes.  There was no fracture, non-union, 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 applicable VASRD §4.71a rating higher than 10% under any applicable code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, coded 5003.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71a.  There were 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Knee Pain	5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170214, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004804, 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