RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01223
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20020706

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Corrections Officer, medically separated for “chronic right knee pain” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 - 20020430	VARD - 20030422	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5299-5003	0%	Right Knee Condition Postoperative	5259	10%	20020910	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee surgery in October 2001 for diagnostic scope, loose body removal and debridement of cartilage flaps and scar tissue. During the 13 February 2002 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported loss of motion in the right leg along with swelling, locking, giving way, and pain in right knee.  Physical examination showed a normal lower extremity evaluation.  At the 21 February 2002 MEB NARSUM examination, 5 months prior to separation, the examiner recorded arthritic symptoms and the CI reported disabling pain after running.  Physical examination showed right knee range of motion (ROM) as 0 - 135 degrees (normal 0 - 140).  The examiner noted mild effusion.  Provocative maneuvers to detect ligamentous, varus or valgus instability were negative.

At the 10 September 2002 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported his right knee would “catch about twice a day as he [was] going into extension.”  He described his pain as aching and rated it at 3-4/10.  Physical examination showed tenderness in the popliteal space and below the patella.  He could flex his right knee to 140 degrees and extend it fully (0 degrees).  The examiner noted mild crepitus with ROM testing and mild pain in the right knee on full extension.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5299-5003 (analogous to degenerative arthritis), citing permanent service aggravation without loss of motion.  The VA rated the right knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic), citing “symptomatic removal of semilunar cartilage or painful or limited motion of a major joint or group of minor joints."  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  Although there was a history of removal of loose body, there was no documentation of loose body or dislocated meniscus causing frequent locking with recurrent effusions to support a rating under code 5258.  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 a history of surgery to debride cartilage flaps to support a 10% rating under code 5259 and there was satisfactory evidence of painful motion with functional loss (based on §4.59, §4.40 and §4.45), that also warranted a 10% rating.  However, the panel notes that separate ratings are not achievable without violation of VASRD §4.14 (avoidance of pyramiding).  After due deliberation, considering all 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 Right Knee Pain	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 

AR20180007353, 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