RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00812
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050722

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Administrative Specialist, medically separated for “left knee pain” with a disability rating of 0%.  

CI CONTENTION:  The VA gave him a higher rating.  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 - 20050427	VARD - 20060610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Patella Femoral Syndrome, Left Knee	5299-5019	10%	20051125	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in the summer of 2003 while deployed, when he fell onto concrete from a standing height.  Radiographs were normal, but a left knee MRI revealed bone marrow edema (bone bruise) of the medial tibial compartment.  There was no surgical indication.  

During the 5 November 2004 MEB NARSUM examination, 8 months prior to separation, the CI reported he was unable to run, walk for more than few 100 yards or navigate stairs.  Physical examination showed no deformity, effusion or warmth, but there was tenderness.  Range of motion (ROM) testing showed flexion of 130 degrees (normal 140) and extension of 0 degrees (normal).  

At the 25 November 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported recurrent pain and a feeling of instability or giving way.  Physical examination showed a normal gait and no swelling.  The left knee ROM following repetitive movement was flexion of 140 degrees and extension of 0 degrees.  There was no painful motion noted on active ROM.  During passive ROM testing, the examiner was able to flex the knee to 145 degrees with the onset of pain at 142 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded analogously to 5003 (arthritis, degenerative).  The VA rated the left knee condition 10%, coded analogously to 5019 (bursitis), citing painful or limited motion of a major joint.  

The panel agreed 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).  No additional functional limitation was evidenced by the examinations.  Although there was evidence of painful motion on the VA C&P examination where the examiner moved the joint beyond 140 degrees of flexion, there was no other evidence proximate to separation to support a 10% rating for painful motion (VASRD §4.59).  Therefore, the panel majority 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 majority concluded that 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 majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 10%, but elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  The panel majority, therefore, recommends that there be 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 20170219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004911, 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