RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01479
BRANCH OF SERVICE:  ARMY	sEPARATION DATE:  20051121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Human Resource Specialist, medically separated for “chronic pain, right knee” 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 – 20051019	VARD - 20051213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	10%	Fracture Right Knee, Post Open Reduction Internal Fixation	5299-5260	10%	20050825	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent an open reduction internal fixation for a right tibial plateau fracture and meniscus tear repair in April 2005.  At the 13 May 2005 orthopedic follow-up, there was mild effusion with tenderness to palpation but not along the joint line.  Range of motion (ROM) was extension of 5 degrees (normal 0) and flexion of 120 degrees (normal 140).  During the 18 July 2005 physical therapy visit, 4 months before separation, the CI had a mild antalgic gait, swelling and effusion; ROM was 2 degrees of extension and 140 degrees of flexion.  At the orthopedic clinic on 4 August 2005, the CI reported that his knee ached and he was unable to fully straighten it.  An effusion of 1+ was noted with extension to 5 degrees and flexion to 125 degrees. 
The 25 August 2005 VA Compensation and Pension (C&P) evaluation, 3 months before separation, noted CI complaints of constant pain rated at 5/10 with stiffness and throbbing.  He had flare-ups 3 times a day, lasting for minutes with pain increasing to 8/10.  Physical examination showed a normal gait and stance, normal appearing knees, and no tenderness.  Right knee ROM was extension of -22 degrees and flexion of 110 degrees.  The examiner listed the diagnosis as healing right tibial plateau fracture with notable decrease in ROM.  

During the 29 August 2005 MEB NARSUM examination, 3 months prior to separation, the CI reported continued pain and inability to return to full activities despite physical therapy.  Physical examination revealed mild effusion with extension of 3 degrees and flexion of 130 degrees.  Painful motion was not recorded and strength was 4/5 in knee flexion and extension.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded analogously as 5003 (degenerative arthritis), citing application of the US Army Physical Disability Agency pain policy.  The VA also rated the right knee condition 10%, coded analogously as 5260, (leg, limitation of flexion).  The panel noted that the extension ROM recorded at the C&P evaluation varied significantly from the other measurements in the record.  The VA examiner stated there was a normal gait, posture and appearance which did not correlate with this limitation of motion, and so the panel agreed that the NARSUM examination, 4 days after the VA examination, aligned with the preponderance of the evidence, was closest to separation, and had the highest probative value for rating. While there was no limitation of motion which supported a rating under diagnostic codes 5260 or 5261, 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 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); and no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  While code 5259 (cartilage, semilunar, removal of, symptomatic) was applicable in this case, the maximum 10% rating provided no benefit to the CI.  After due deliberation, considering all of 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 right knee condition.  

BOARD FINDINGS:  In the matter of the right 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 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

 AR20180004890, 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.

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure