RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00826
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Heavy Construction Equipment Operator, medically separated for “chronic left knee pain” 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 - 20071011	VARD - 20080626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5003	0%	Degenerative Joint Disease of Left Knee	5010	10%	20080426	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a history of left knee pain dating to at least 2002.  This resulted in five arthroscopic surgical interventions, all related to meniscectomy and/or debridements, with the last one on 19 September 2006 (16 months before separation).  There was ample STR documentation of normal to modestly limited range of motion (ROM), absence of persistent effusion, absence of impingement or locking, and of a normal gait.  There were no contrary STR entries for any of these findings, none that suggested any more significant ROM limitation, and none that documented any additional VASRD-ratable findings.

The 5 September 2007 MEB NARSUM, 4 months prior to separation, documented constant left knee pain rated 3/10 that prohibited running and was exacerbated by stairs and climbing.  The physical examination recorded medial joint line tenderness, healed surgical portals, and the absence of atrophy without comment regarding effusion, impingement, or gait.  The NARSUM cited goniometric ROM measurements conducted by physical therapy for the MEB on 17 August (3 weeks earlier).  These were flexion to 137 degrees (normal 140) and minus 10 degrees extension (normal 0), specifying painful motion.  Of note the 10 degrees of hyperextension was symmetric with the right knee (i.e., suggestive of baseline laxity) and not corroborated by multiple ROM measurements (including by orthopedics) in the STR.  

The 26 April 2008 VA Compensation and Pension (C&P) evaluation, 4 months after separation, did not document any interim injury or other exacerbation of the condition.  Of note the gait and functional limitations were confounded by concurrent complaints of right knee pain, left ankle pain, and bilateral foot pain.  The VA examiner noted nonspecific left knee pain and use of a brace without complaints of persistent effusion or locking.  Documented functional impairment was limitation of standing to one hour and walking to less than a mile.  The physical examination recorded an antalgic gait, crepitus, a nonspecific effusion, and no impingement.  Measured ROM was flexion to 90 degrees with 0 degrees extension, specifying painful motion but no ROM degradation with repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5003 (degenerative arthritis), citing “full range of motion of the knee joint and no evidence of instability.”  The VA rated the left knee condition 10%, coded 5010 (arthritis, due to trauma), citing painful motion.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that code.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case, and provided an alternate route to a 10% rating.  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 left knee condition, coded 5259.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  There are 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Left Knee Pain	5259	10% 	

The following documentary evidence was considered:

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

AR20180004916, 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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure