RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01098
BRANCH OF SERVICE:  army	SEPARATION DATE:  20061110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic right knee pain status post-surgical realignment for unstable patellar mechanism” with a disability rating of 0%.  

CI CONTENTION:  “Had right knee surgery which prevented me from doing my job.”  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 - 20060929	VARD - 20080130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Chronic Right Knee Pain…	5260-5014	10%	20071103	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right Knee.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in 1995 when he dislocated his right lateral patellar after striking his knee against another individual’s knee.  He underwent right knee surgery to stabilize and realign the patella in December 2005.  Despite surgery the CI was unable to kneel on this knee nor run any distance secondary to knee pain.  Two orthopedics evaluations, in January and June 2006, revealed right knee range of motion (ROM) of flexion from “full” in January to 110 degrees in June (normal 140); extension was 0 degrees (normal); painful motion was not addressed.  

The 13 July 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of right patella instability but no frank dislocations since surgery.  Physical examination showed right knee tenderness but no effusion.  Ligamentous and patellar stability testing was negative.  “Passive” ROM was extension to 0 degrees and flexion to 140 degrees; painful motion, active ROM, gait, and crepitus were not addressed.  The knee was stable and evidence of lateral patellar subluxation was absent.  At the 24 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported his knee will give out.  Physical examination showed “full ROM,” and no significant ligament laxity or effusion.  

During the 3 November 2007 VA Compensation and Pension (C&P) joints examination, 11 months after separation, the CI reported occasional right knee pain without giving way or instability.  Physical examination revealed a normal gait, right knee crepitus, motor strength was 5/5, and stability testing was negative.  ROM was extension to 0 degrees and flexion to 140 degrees; painful motion was not addressed.  There was no loss of motion with repetition. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing the right knee was rated for slight and intermittent pain.  The VA rated the right knee condition 10%, analogously coded 5260-5014 (leg, limitation of flexion-osteomalacia) based on the C&P examination, citing painful motion of a major joint.

The panel agreed there was no limitation of flexion or extension proximate to separation that supported a minimum rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no evidence of postoperative patella instability or lateral instability to support a 10% rating under the 5257 code (knee, other impairment).  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).  There was no objective evidence of painful motion with functional loss documented during service. However, the panel majority agreed that there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45), as recorded by the VA examination as crepitus.  After due deliberation, and in consideration of all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the right knee condition coded 5260-5014 IAW 4.71a.

BOARD FINDINGS:  In the matter of the right knee pain condition, the panel majority recommends a disability rating of 10%, coded 5260-5014 IAW VASRD §4.71a.  The single voter for dissent recommends no change and elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.   

The panel recommends that the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain Status Post -Surgical Realignment for Unstable Patellar Mechanism	5260-5014	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007240, 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.

Sincerely,					      
Enclosure