RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01511
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070319

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Food Service Operations, medically separated for “chronic right knee” with a disability rating of 10%.   

CI CONTENTION:  “My condition has worsened and has caused/affected other body parts to have impairments.”  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 - 20070209	VARD - 20070627	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Rt Knee	5099-5003	10%	Patellofemoral Syndrome, Rt Knee…	5099-5014	10%	20070531	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Knee.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s chronic right knee condition began in 2004 while in basic training.  No trauma or injury was reported.  The knee pain was initially treated with physical therapy and improved, however, after reporting to her first assignment she continued to have knee pain.  An MRI in February 2006 revealed a medial plica.  Despite aggressive rehabilitation, the condition did not improve and the CI underwent arthroscopic procedure of the right knee (July 2006).

During the 19 January 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, physical examination showed decrease range of motion (ROM) with pain on flexion.  The MEB NARSUM examination on the same day noted the complaint “My knee is hurting worse since they did surgery.”  The CI reported intermittent pain that occurred with prolonged standing and sitting, and with activity.  X-rays showed no evidence of fracture, dislocation, joint effusion or other abnormality.  ROM documented flexion to 120 degrees (normal 140) with pain, and extension -5 with pain.

At the 31 May 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported pain, stiffness and occasional give-way and pain with walking up steps.  Physical examination showed normal gait and normal appearing knees.  ROM recorded 110 degrees of flexion that decreased to 98 degrees after repetitive motion.  Painful motion was present but there was no instability.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right knee pain condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the patellofemoral syndrome right knee condition, status post arthroscopy 10%, analogously coded 5099-5014 (osteomalacia), based on the C&P examination, citing painful motion or limited motion of a major joint or group of minor joints.

There was no compensable 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) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating 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).  There were no grounds for additional rating based on the presence of instability.  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 chronic right knee condition.  

BOARD FINDINGS:  In the matter of the chronic right knee condition and IAW VASRD §4.71, 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 20170224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180009588, 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