RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01714
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E3, Unit Supply Specialist, medically separated for “chronic right knee pain” with a disability rating of 0%.  

CI CONTENTION:  She cannot perform occupational duties due to her injury and seeks an increase in rating to 30% to qualify for vocational rehabilitation.  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 - 20050210	VARD - 20060524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Right Knee Patella Femoral Syndrome	5299-5257	10%	20060505	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent arthroscopic evaluation in April 2003 with debridement of a symptomatic right knee medial plica (synovial flap).  Also at the time of surgery, chondromalacia of the medial femoral condyle was noted along with some lateral patellar compression.  She did not obtain significant relief from the surgery and was scheduled for a second procedure (lateral retinacular release), but it was not performed because of pregnancy and relocation out of the area.  Right knee X-rays on 12 August 2004 showed very mild joint space narrowing involving the medial compartment, but were otherwise unremarkable. 
During an orthopedic visit on 28 October 2004, 6 months before separation, the CI reported continued right knee pain, but denied locking, catching or giving way.  The examiner recorded negative Lachman’s (to determine laxity), McMurray’s (to determine a meniscal tear), and varus/valgus (medial/lateral) stress tests.  Right knee range of motion (ROM) tests showed flexion to 130 degrees (normal 140) and “full” extension; painful motion was not addressed.  

The 5 January 2005 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of daily right knee pain, aggravated by stooping, bending, squatting, climbing, running and with any attempts at aerobic physical training.  She took ibuprofen occasionally and wore a knee brace to alleviate symptoms.  Physical examination showed marked right quadriceps atrophy, measuring 42cm compared to 46cm on the left.  Motor strength above the knee was normal and there was no erythema.  There was tenderness over the medial femoral condyle, and some pain with patellar compression, but no joint effusion. Lachman’s testing was 1-A. McMurray’s testing was negative, and the knee was stable to varus and valgus stress.  Measured ROM was normal, with no mention of painful motion.  

At the 11 March 2005 orthopedic consult, 1 month before separation, the examiner documented that the CI was “able to squat only to about 90 degrees and then is stopped by pain in her right knee.”  There was tenderness, but no effusion or retropatellar crepitus (grinding sensation).  Lateral terminal shift or bayoneting of the patellar tendon was not recorded.  Hip and ankle motion were reported as “full” and without pain, but right knee ROM was not mentioned.  The provider opined that a lateral retinaculum release would not be beneficial because the pain was medial.  Right knee X-rays taken that day were normal, and a 31 March 2005 MRI showed only minimal right patellar chondrosis (cartilage deterioration).  

At the 5 May 2006 VA Compensation and Pension (C&P) examination, less than 13 months after separation, the CI reported had no orthopedic follow-up since the MRI in March 2005.  She had daily right knee pain, rated at 6/10, and aggravated by descending stairs, squatting, or prolonged standing.  Physical examination showed a normal gait with no right knee effusion or edema.  She had subjective medial joint line tenderness, but McMurray’s, Lachman’s, and drawer (to determine laxity) tests were negative with no lateral or medial instability.  Measured ROM after repetition showed that the CI “resisted flexion” at 100 degrees, with 2 degrees of extension and painful motion noted.  The examiner stated that the ROM testing “was met with muscular resistance and [did] not consider this to be a maximal measurement.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing normal motion and radiographs.  The VA rated the right knee condition 10%, analogously coded 5299-5257 (knee, other impairment of), based on the C&P examination, citing minimal knee disability.  Members agreed that there was no limitation of flexion or extension that supported ratings under codes 5260 or 5261; no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); or history of surgery to remove a meniscus (5259).  Additionally, 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) as documented on the orthopedic examination closest to separation.  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.  

BOARD FINDINGS:  In the matter of the chronic right knee pain, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  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	
Chronic Right Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180011413, 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.

Sincerely,					      
Enclosure