RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-01303
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060314

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Truck Driver, medically separated for “chronic left knee pain” with a disability rating of 0%.

CI CONTENTION: “Progressive degeneration, arthritic pain, expanding to other joints due to compensation.”  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 - 20060228	VARD - 20060413	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Left Knee [Surgical Residuals]	5299-5260	10%	STR	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic Left Knee Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent an arthroscopic left knee plica resection in November 2005 for pain that had developed early in basic training. Post-operative provider entries in the STR noted the absence of any complications. An orthopedic note on 7 December 2005 documented range of motion (ROM) showing flexion to 135 degrees (normal 140) and extension to minus 3 degrees (normal 0), without addressing painful motion. A subsequent entry recorded grossly normal ROM, also without addressing painful motion. There was no additional evidence which suggested any significant ROM limitation, persistent effusion and locking, instability, gait disturbance, or any other VASRD-ratable findings.

At the 25 January 2006 MEB NARSUM examination, 2 months prior to separation, the CI complained of an “inability to even do rehabilitation on the elliptical trainer.” The examiner noted persistent, slight/intermittent left knee pain with mild patellar tenderness, full joint strength, and no crepitus, effusion, impingement, instability, or gait disturbance. The examiner also documented “full” active ROM without addressing painful motion. There was no VA examination or other evidence temporally probative to separation.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing criteria of the US Army Physical Disability Agency pain policy. The VA rated the condition 10%, coded 5299-5260 (analogous to limitation of flexion), based on STR evidence and citing painful motion from the NARSUM examination. Panel members agreed there was no compensable limitation of flexion or extension (5260 or 5261); 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 ratings under the respective 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). The panel deliberated whether there was satisfactory evidence of painful motion to support the minimum 10% rating IAW VASRD §4.59, and ultimately agreed that there was not sufficient evidence for conceding painful motion. Although the VA rater referenced NARSUM evidence of painful motion, there was no specific documentation of painful motion (or its absence) in the NARSUM or by any other examiner. There was documentation of pain with use, but this was in the context of repetitive or more rigorous activities, and could not be equated to pain with simple active motion. It was also considered that the available evidence was still relatively close to surgery, and that the clinical pathology was fairly mild (no expectation of persistent pain and functional impairment). After due deliberation, considering all 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 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 that there be no modification or re-characterization of the CI’s disability and separation determination.

PD-2017-01303

AR20190012265, XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX

	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.