RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00898
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20080813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police, medically separated for “left knee pain” with a disability rating of 10%.  

CI CONTENTION:  She needed emergent surgery after getting MRSA from first surgery.  Her knee condition has worsened.  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 - 20080505	VARD - 20090217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Status Post Left Knee Plica Excision	5099-5024	10%	20081006	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee arthroscopy 19 March 2007 with findings of a medial plica (which was removed), a partial anterior cruciate ligament tear, and patellar instability.  She was taken to the operating room again on 23 March 2007 for evacuation of a postoperative hematoma.  Cultures from the evacuated material were negative for bacteria.  After extensive physical therapy (PT) she was unable to return to unrestricted duty.  

The 22 January 2008 MEB NARSUM examination, 7 months prior to separation, noted complaints of pain on the anteromedial aspect of the knee with a clicking and locking sensation.  She had pain with prolonged standing, prolonged brisk walking, or running.  Physical examination showed a non-antalgic gait, no effusion, and range of motion (ROM) of extension to 0 degrees (normal) and flexion to 140 degrees (normal) with pain at full flexion.  A 30 January 2008 PT visit reported ROM as extension to 0 degrees and flexion to 113 degrees with flexion limited by pain.  

At the 06 October 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported pain in the inner knee and kneecap which occurred constantly and was elicited by physical activity and standing.  At the time of pain she was able to function with medication.  Physical examination demonstrated flexion to 128 degrees with pain at the end of motion and extension to 0 degrees with no additional joint function limitation due to pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use.  X-ray images taken during the examination were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion of one major joint.  The VA rated the left knee condition 10%, analogously coded 5099-5024 (tenosynovitis), based on the C&P examination, citing painful or limited motion of a major joint.  

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 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).  There was therefore no VASRD §4.71a route to a 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 20170223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004951, 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