RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01071
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060427

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

CI CONTENTION:  The CI contends his right knee, left knee, and a head injury.  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 - 20060227	VARD - 20070126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain Right Knee	5099-5003	0%	S/p Arthroscopy, Chondromalacia Patella and Tendonitis, Right Knee 	5024	10%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Pain Right Knee.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported a four year history of chronic right knee pain.  No specific trauma or injury was reported.  In September 2004, he underwent a diagnostic arthroscopy where a debridement of the chronic patella tendonitis was done.  A diagnosis of chondromalacia patella was rendered.  Despite operative management, physical therapy, and temporary profiling, the CI’s right knee pain and functional limitations continued.  On 13 September 2005 X-rays demonstrated no bony abnormalities.  An undated MRI showed thickening of the patella tendon, consistent with patella tendinopathy, with similar changes noted about the medial lateral facets and patella, consistent with chondromalacia patella.  

During the October 2005 MEB examination (recorded on DD Forms 2807 and 2808) 6 months prior to separation, physical examination showed right knee crepitus.  The 14 October 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of debilitating right knee pain.  Physical examination showed a well healed surgical scar over the anterior aspect of the knee distal to the inferior pole of the patella.  No effusion, erythema, or ecchymosis was noted.  Atrophy of the right quadriceps muscle group was noted with range of motion showing flexion of 140 degrees (normal) “with increased pain at the upper limits of flexion.”  There was no positive patella grind.  Patella apprehension test, Lachman’s, anterior drawer, and McMurray’s were negative (signs for instability).  The right knee was stable to varus and valgus stress.  No VA examination was in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing flexion to 140 degrees.  The VA rated the right knee condition 10%, coded 5024 (tenosynovitis), based on the STR, citing painful motion.  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).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).   There was no fracture, non-union, 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 10% under any applicable code, and no grounds for additional rating based on the presence of instability.  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 right knee condition, coded 5099-5003  

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5099-5003 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 Pain Right Knee	5099-5003	10%	

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 Record 

AR20180004763, 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 to 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.

Sincerely,					      
Enclosure