RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01621
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Wire Systems Equipment Repairer, medically separated for “chronic right knee pain” with a disability rating of 0%.

CI CONTENTION:  The CI made no contention, but her representative requested “all appropriate development…be completed as soon as possible.”  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 - 20060328	VARD - 20070720	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Patellofemoral Syndrome Right Knee	5259	10%	20070419	
Right Shoulder Pain	Not Unfitting 	Impingement Syndrome, Right Shoulder	8611-5024	0%	20070419	
Gastroesophageal Reflux 	Not Unfitting	Peptic Ulcer Disease…	7305	10%	20070419	
Hypertension	Not Unfitting	Hypertension	7101	NSC	20070419	
Hyperlipidemia 	Not Unfitting	Hyperlipidemia	7799-7700	NSC	20070419	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery on 3 February 2006 for chondromalacia patella.  At the MEB NARSUM orthopedic addendum on 6 March 2006, 1 month post-surgery and 1 month prior to separation, the CI reported that her knee felt the same to slightly worse.  The pain was exacerbated by exercise.  On examination the range of motion (ROM) was noted to be 0-120 degrees (normal 0-140).  There was a small effusion and lateral retropatellar tenderness.  At the 13 July 2006 VA clinic examination, 3 months after separation, the CI complained of right knee pain for the past 4 days.  Physical examination showed slight effusion along the suture line.  Radiographic studies on 25 July 2006 showed soft tissue swelling around the right knee.  At the rheumatology consult on 26 July 2006 the CI reported poor pain relief from medication therapy.  Examination showed tenderness of the medial joint line and soft tissue swelling of the prepatellar bursa.  There was pain on full ROM, but no ligamentous instability.  

At the 28 September 2006 orthopedic clinic visit, 6 months after separation, the CI complained of 8/10 right knee pain.  Examination showed 0-120 degrees of ROM, positive joint line tenderness, and crepitus.  Tests for ligamentous instability or meniscal pathology were negative.  At the 19 April 2007 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported 6 or 7/10 right knee pain and difficulty with bending and squatting.  Repetitive motion increased the pain without any additional loss of motion.  Physical examination showed no swelling or effusion.  ROM was 0-135 degrees with pain at the end range of motion.  Tests for ligamentous instability and meniscal pathology were negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing degenerative joint disease with full motion.  The VA rated the right knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic), citing symptomatic removal of semilunar cartilage.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right knee condition, coded 5099-5003.  

Contended PEB Conditions:  Right Shoulder Pain, Hypertension, Gastroesophageal Reflux Disease, and Hyperlipidemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  In the matter of the contended right shoulder pain, hypertension, gastroesophageal reflux disease, and hyperlipidemia, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170301, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005259, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX. 

Sincerely,					      
Enclosure