RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01317
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20081030

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Metal Worker, medically separated for “tricompartmental osteoarthritis of the left knee” with a disability rating of 10%.

CI CONTENTION:  “Leg does not work well when moving and is painful when in use.  I also have some stiffness in the leg.”  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 - 20080826	VARD - 20090105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tricompartmental Osteoarthritis of the Left Knee	5003	10%	Left Knee, Postoperative with Scars	5261	20%	20081027	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Tricompartmental Osteoarthritis of the Left Knee.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent multiple surgical procedures about the left knee during 2007.  Secondary to persistent left knee pain coupled with the inability to perform various physical activities, the CI was permanently profiled in May 2008 and referred for MEB.  During the 5 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported a history of left leg weakness, loss of motion, and pain.  His physical examination (PE) revealed an antalgic gait and tenderness about the joint line of the left knee.  There was no knee swelling or effusion present.  Left knee range of motion (ROM) documented decreased extension, but no numerical measurements were provided.  There was 4/5 motor weakness of the left lower extremity manifested in the quadriceps and hamstrings.  

At the 21 July 2008 MEB NARSUM examination, 3 months prior to separation, the CI’s chief complaint remained as “left knee pain”.  His PE revealed left knee ROM of 112 degrees of flexion (normal 140) after repetition.  Extension measurements were not listed.  Provocative tests to elicit signs of joint instability were negative.  

At the 27 October 2008 VA Compensation and Pension (C&P) examination, 3 days before separation, the CI reported left knee weakness, stiffness, fatigue, and lack of endurance that was constant in nature.  Precipitating factors were physical activity and inclement weather.  He also had “difficulty navigating stairs, walking and running long distances, or standing stationary for extended lengths of time.”  The CI denied any dislocations or recurrent subluxations of the knee joint.  His PE showed two non-tender surgical scars.  There was no swelling, effusion or ligament instability about the left knee.  However, there was “tenderness to palpation throughout the anterior knee” and during ROM testing he was noted to lack 15 degrees of extension, but had 130 degrees of flexion.  There was no pain on motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5003 (degenerative arthritis), citing “limitation of motion of one major joint.”  The VA rated the left knee condition 20%, coded 5261 (limitation of extension), based on the C&P examination, citing “limitation of 15 degrees of extension.”  The VA examination recorded left knee extension limited to 15 degrees which supported a 20% rating under code 5261 (extension limited to 15 degrees).  There was no limitation of flexion that supported a minimum rating under the VASRD diagnostic code for limitation of flexion (5260).  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).  No additional functional limitation was evidenced by the examinations.  There was therefore no VASRD §4.71a route to a higher rating under any applicable code.  The panel does not recommend disability rating for scars unless their presence imposed a direct functional limitation that rendered the CI unfit.  The knee scars did not interfere with wear of military gear and were not painful at the MEB examination.  Any impact from the scars on ROM limitation was addressed above.  There was insufficient evidence of duty-limiting impairment from the knee scars, thus the panel concluded that the scars could not be recommended for additional disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the left knee condition, coded 5261.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel recommends a disability rating of 20%, coded 5261 IAW VASRD §4.71a.  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	
Tricompartmental Osteoarthritis of the Left Knee	5261	20%	

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 

AR20180004940, 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 provide to the Department of Veterans Affairs.

Sincerely,					      
Enclosure