RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01239
BRANCH OF SERVICE:  army	SEPARATION DATE:  20071210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Cannon Crewmember, medically separated for “left knee pain” with a disability rating of 10%.

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 - 20070904	VARD - 20080502	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	S/P Left Knee…Residual Scarring	5260-5024	10%	20080226	
Left Ear Hearing Loss	Not Unfitting	Left Ear Hearing Loss	6100	0%	20080218	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Left Knee Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in July 1999 after being struck by a vehicle as a pedestrian.  He reinjured the left knee in August 2003 when he fell on a rocky surface while deployed to Afghanistan.  The CI underwent five left knee surgeries from August 2005 to December 2006.  Diagnostic imaging (MRI) taken in March 2007 demonstrated post-surgical changes to the left medial tibia; lesion involving the medial femoral articular cartilage consistent with the recent graft placement; small joint effusion; osteoarthritic spurring of the patella; and patellar tendinitis change.  Orthopedics and physical therapy evaluations from December 2006 to June 2007 (12 to 6 months before separation) revealed left knee range of motion (ROM) ranging from flexion 80 to 135 degrees (normal 140) while extension ranged from 0 to 10 degrees (normal 0); painful motion was not addressed.

The 13 July 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic left knee pain with frequent swelling and popping.  Physical examination showed an antalgic gait; mild effusion, motor strength was 5/5, lower extremity was neurovascular intact and knee tenderness was present.  There was no patellar grind.  Instability and meniscus testing were negative.  ROM was measured as “full active without painful motion.”

At the 26 February 2008 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported a left knee which was weak, stiff, swollen, gave way, lacked endurance and locked up. He experienced both daily and intermittent pain that radiated down the leg.  Physical examination revealed no swelling, effusion, locking or crepitus.  Instability and meniscus testing were within normal limits.  Repetitive-ROM was extension to 0 degrees and flexion to 80 degrees with pain-limited motion.

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 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the left knee condition 10%, coded 5260-5024 (leg, limitation of flexion-tenosynovitis), based on the C&P evaluation, citing pain-limited motion.

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).  However evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) was documented by the MEB NARSUM and VA examinations most proximate to separation.  There was no evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) proximate to separation.  The 5259 code (symptomatic removal of semilunar cartilage) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  There was a fracture, but no nonunion or malunion of the femur to support consideration under the respective code for knee impairment related to long bone condition (5255).  After due deliberation, considering all 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.

Contended PEB Condition:  Left Ear Hearing Loss.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was profiled H2 indicating a medical condition or physical defect that may require some activity limitations.  However, the condition was not implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the left knee pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended left ear hearing loss condition, the panel agrees it cannot recommend it for additional disability rating.  There were 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 20170303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008611, 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