RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-01576 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060511

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Cargo Specialist, medically separated for “left knee pain” with a 0% disability rating.

CI CONTENTION: In addition to the left knee, the CI also 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 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 - 20060303	VARD - 20061226	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Residual of Left Knee Injury	5099-5014	10%	20060926	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Left Knee Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent arthroscopic debridement of synovium and lateral release surgery in June 2004. The CI had significant post-operative stiffness and underwent manipulation under anesthesia in September 2004. An MRI in June 2005 documented thickened medial patellar plica with associated medial patellar facet chondromalacia. The 4 November 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of persistent left patellar pain aggravated by prolonged standing, walking or stairs. He was unable to participate in any running or sports activities, and could not complete his physical fitness test. Physical examination showed left knee range of motion (ROM) from 0 to 135 degrees (normal 0 to 140). There was some tenderness, but no laxity or instability. The 24 October 2006 physical therapy ROM study showed flexion of 135 degrees and extension of 0 degrees. Reason for limitation was “tissue approximation,” not pain.

At the 26 September 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant localized 6/10 left knee pain elicited by physical activity and

relieved by rest. Physical examination revealed normal posture and gait. There were no signs of edema, effusion, weakness, tenderness, redness, heat, abnormal movement or guarding of movement. Left knee ROM was normal and there was no limitation of motion with repetition. The left knee was ligamentously stable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy. The VA rated the left knee condition 10%, analogously coded 5099-5014 (osteomalacia), based on the C&P examination, citing painful motion. Although there was no history of surgery to remove a meniscus for direct rating under code 5259 (cartilage, semilunar, removal of, symptomatic), there was history of synovium debridement with post-surgical evidence of cartilage degeneration and thickened plica (synovium) which the panel majority adjudged supported a 10% rating coded 5099-5259 supported by functional loss (based on §4.20, §4.40 and §4.45) as an analogous rating. The panel considered other VARSRD knee and analogous codes, but all were less applicable or not advantageous for rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the left knee condition, coded 5299-5259.

BOARD FINDINGS: In the matter of the left knee condition, the panel majority recommends a disability rating of 10%, coded 5099-5259 IAW VASRD §4.71a. The single voter for dissent recommends no change and does not elect to submit a minority opinion. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Pain	5099-5259	10%	

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

AR20190015700, 

Dear: XXXXXXXXXXXXXX

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 provided to the Department of Veterans Affairs