RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01343
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20070808

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Shower, Laundry, and Clothing Repair Specialist, medically separated for “chronic pain, left knee” with a disability rating of 10%.

CI CONTENTION:  He has chronic pain in his left knee, and requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070604	VARD - 20080516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	10%	Left knee Patellofemoral Arthrosis…	5099-5257	30%	20080227	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Left Knee.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in June 2004 after he twisted it while running at basic training.  An MRI revealed a left knee partial anterior cruciate ligament (ACL) tear.  X-rays showed a normal left knee with no evidence of fracture, dislocation, or effusion (fluid buildup), but degenerative arthritis was present.  Orthopedics determined the CI was not a surgical candidate.  The CI was treated by primary care and physical therapy for chronic left knee pain before MEB referral.  

During the 17 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported his partially torn ACL.  Physical examination showed a normal gait, no crepitus, but left knee pain with squatting (painful motion).  At the 1 May 2007 MEB NARSUM examination, 3 months prior to separation, the CI complained of left knee pain when running, sitting, and standing, but denied locking or giving way.  Physical examination revealed tibial tubercle (shin bone right below the knee) with tenderness but no effusion.  Stability testing was negative.  The examiner noted the ACL injury had resolved.  Range of motion was flexion to 95 degrees (normal 140) and extension to 0 degrees (normal); painful motion was not addressed.  

At the 27 February 2008 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported intermittent left knee pain aggravated by prolonged sitting, standing, running, or walking.  He denied locking but complained of occasional left knee giving way when going up or down stairs or after prolonged walking.  Physical examination showed a normal gait.  There was left tibial tubercle tenderness.  Stability and meniscus testing was negative.  Flexion was 90 degrees, reduced to 60 degrees with repetition due to pain.  Extension was not addressed.  

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 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the left knee condition 30%, analogously coded 5099-5257 (knee, other impairment), based on the C&P examination, citing laxity and loss of motion with repetitive use.  

The panel agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261); however, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  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).  Additionally, evidence of instability was insufficient to warrant a rating higher than 10% under the 5257 code.  There was no VASRD §4.71a rating option higher than the 10% adjudicated by the PEB under any applicable code.  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.  

BOARD FINDINGS:  In the matter of the chronic left knee pain 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 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 20170207, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007721, 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