RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01046
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Unit Supply Specialist, medically separated “left knee pain” with a disability rating of 10%.

CI CONTENTION:  The CI contends that he should have been medically retired instead of separated due to major surgery of his left knee.  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 - 20060816	VARD - 20070309	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Degenerative Arthritis with Patella Femoral Syndrome…	5010	10%	20070117	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI underwent left knee surgery in March 2004 for quadriceps tendon repair.  A post-surgical (April 2006) magnetic resonance imaging (MRI) showed no abnormalities and post-surgical (April 2006) X-rays were consistent with previous surgery, but also showed chondromalacia patellae.  At the 12 June 2006 physical therapy range of motion (ROM) study, 2 months prior to separation, the CI reported 6/10 left knee pain.  On examination he was noted to have a minimally antalgic gait without assistive device.  Strength was noted to be 4/5 with left knee flexion and extension due to suprapatellar pain.  There was minimal tenderness to the quadriceps tendon.  Forward flexion was 99 degrees after repetition (normal 140) and extension was 0 degrees after repetition (normal).  The patellar compression test was positive and the right quadriceps was noted to be “tight.”  

During the 13 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported knee and joint problems after his quadriceps tendon repair.  Physical examination showed decreased strength with left knee extension.  The 10 July MEB NARSUM, 1 month prior to separation, noted constant left knee pain from 5/10 at best and 10/10 at worst.  On examination, his muscle strength (5/5), reflexes and gait were normal.  There was good muscle tone “except for the quadriceps tendon.”  There was no effusion, but there was tenderness of the suprapatellar region.  ROM was 0-120 degrees (normal 0-140).  Provocative testing to elicit knee instability was negative, but the examiner noted that the CI had a 1A Lachman’s (test for ACL tear). 

At the 17 January 2007 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported 8/10 left knee pain at its worst.  His condition was exacerbated with climbing up ladders and stairs.  The CI reported that he could mow a lawn, but needed to take frequent breaks.  He denied use of regular medications.  Physical examination showed normal gait and posture and his feet did not show any signs of abnormal weight bearing.  There was no swelling, effusion, locking, subluxation or weakness, but there was tenderness along the inferior patella tendon and medial joint line.  ROM testing showed 140 degrees of flexion and 0 degrees of extension.  However due to fatigue and pain, his flexion decreased to 120 degrees and his extension decreased to 5 degrees.  There was no ligamentous instability noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA also rated the left knee condition 10%, coded 5010 (traumatic arthritis), 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 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 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 unanimously 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 20170227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005837, 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