RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01567
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20050228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Supply Specialist, medically separated for “chronic right knee pain” with a disability rating of 10%. 

CI CONTENTION:  “Review of 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 - 20041216	VARD - 20050701	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	Right Knee Post Meniscectomy Repair	5299-5260	0%	20050513	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery on 9 March 2004, which included debridement of an anterior horn beak tear and repair of the posterior horn vertical cleavage tear of the medial meniscus.  At a 20 July 2004 physical therapy examination, 7 months prior to separation, the examiner noted the CI was doing well and had minimal pain with running and wore a patellar brace.  Physical examination showed a normal gait, the ability to squat and full range of motion (ROM).  However, at the 23 September 2004 orthopedic examination, 5 months prior to separation, the CI was not able to kneel, squat, run or jump.  Physical examination showed full ROM without effusion, laxity or evidence of a meniscal tear. 

The 30 November 2004 MEB NARSUM examination, 3 months prior to separation, showed right knee flexion of 170 degrees (normal 140) with painful motion and extension of 0 degrees (normal).  Left knee flexion was 130 degrees and extension was 0 degrees without any pain.  There was no crepitation (grinding) and no effusion.  Mild laxity of the medial collateral ligament (MCL) was present along with tenderness over the medial meniscal area and anterior tibial plateau.  

At the 13 May 2005 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported pain with running, climbing stairs and walking long distances.  Physical examination showed right knee flexion of 140 degrees and extension of 0 degrees.  The ROM was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.  There was no laxity or evidence of a meniscal tear and the CI’s gait was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5099-5003 (arthritis, degenerative), citing the U.S. Army Physical Disability Agency pain policy.  The VA rated the right knee condition 0%, coded 5299-5260 (limitation of flexion), based on the C&P examination, citing non-compensable leg flexion limited to 60 degrees.

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) to support a rating under that code.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case, but the maximum 10% rating under that code provided no additional benefit to the CI.  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).  Therefore, there was no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007949, 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