RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00791
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20080418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “left knee pain” with a disability rating of 10%.  

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 - 20080331	VARD - 20080922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	Osteoarthritis of the Left Knee	5010-5262	20%	20080625	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent surgery to repair a tibial plateau fracture on 23 June 2007.  The 15 February 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic left knee pain which increased with prolonged standing, walking or any impact activity.  Physical examination showed a mildly antalgic gait, which favored the left leg.  There was mild numbness along the edges of the scar and mild tenderness of the lateral tibial plateau.  Muscle strength was 5/5 and the left lower extremity was neurovascularly intact.  The left knee range of motion (ROM) was flexion of 96 degrees (normal 140), limited by pain, and extension of 0 degrees (normal).  
At the pain management appointment on 27 May 2008, 1 month after separation, the CI reported left knee pain that worsened with prolonged sitting, walking or climbing stairs.  The examiner noted the gait was steady and symmetrical.  There was presence of soft tissue swelling at the proximal end of the tibia and crepitus.  The CI had full active ROM with pain observed on flexion.  There was 5/5 strength with flexion and extension.  

At the 25 June 2008 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported chronic left knee pain after prolonged sitting and walking.  Physical examination showed a normal gait.  There was mild edema and quadriceps muscle strength was 4 of 5.  Stability was within normal limits.  ROM of the left knee was flexion of 120 degrees and extension of 0 degrees.  Pain started and ended at 120 degrees with repetitive measurements using a goniometer.  X-rays showed intact hardware with no evidence of fracture or loosening of the metallic plate and screws nor evidence of joint effusion.  

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 painful and limited ROM.  The VA rated the left knee condition 20%, coded analogously to 5262 (tibia and fibula, impairment of), based on the C&P examination 2 months after separation, citing malunion of the tibia and fibula with moderate knee or ankle disability to include compensation for reduced muscle strength and intermittent swelling.  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 nonunion or malunion of the tibia to support consideration under the code for knee impairment related to a long bone condition (5262).  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004908, 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