RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01764
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-4, Motor Transport Operator, medically separated for “chronic pain, left knee,” with a disability rating of 10%.  

CI CONTENTION:  In addition to the left knee condition, the CI 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’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 - 20070329	VARD - 20071108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5299-5259	10%	Left Knee Trauma Residuals 	5259	10%	20070617	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent multiple left knee surgeries from March 2005 through June 2006, with the most recent surgery occurring on 20 June 2006.  Surgeries included meniscal repairs, but the last operation was a diagnostic arthroscopy and ACI (autologous chondrocyte implantation).  During the 6 December 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation (5 months after surgery), the CI reported constant left knee pain aggravated by climbing, walking, bending, cold weather and impact activities, and was associated with popping, giving way and swelling.  Physical examination showed sub-patellar tenderness.  Range of motion (ROM) testing showed no limitation, but there was evidence of painful motion and crepitus.  The CI had a limping gait and could not perform the heel walk.  Left lower extremity motor strength was decreased (4/5), but the neurovascular evaluation was otherwise normal. 

The 9 February 2007 MEB NARSUM examination, 3 months prior to separation, noted improvement of symptoms since the most recent surgery, but the CI was unable to efficiently go up and down stairs or carry weights.  He reported some instability described as a twisting sensation while walking.  Physical examination showed extension-to-flexion of 0-130 degrees (normal 0-140).  There was joint line tenderness, tenderness over the surgical site and a minimal effusion.  Meniscal testing and tests for instability or laxity were negative.  The CI was neurovascularly intact in the left lower extremity.  

At the 17 June 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant 7-10/10 left knee pain that was sharp with intermittent swelling, heat and redness, and increased when walking or going up and down stairs.  The CI also reported instability, giving way, fatigability, lack of endurance and crepitus.  Flare-ups occurred with repetitive activity such as stair climbing.  The CI used no assistive devices.  X-rays from February 2007 showed proximal tibial screws with irregular ossification to the right distal femur.  On examination, there was a normal gait and nonspecific left patella tenderness with marked crepitance and clicking of the left knee joint during active and passive ROM testing.  The ROM evaluation showed painful motion with flexion of 130 degrees and extension of 0 degrees.  There was no weakness, apparent fatigue or incoordination with repetitive ROM testing.  Tests for Deluca were negative.  There was no laxity or instability and meniscal testing was negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5299-5259 (cartilage, semilunar, removal of, symptomatic), citing pain limited motion.  The VA also rated the left knee condition 10%, coded 5259, based on the C&P examination, citing painful limitation of motion.  

There was no limitation of motion which supported a rating under the diagnostic codes for 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).  The 5259 meniscal code was properly used by the PEB in this case and supported a 10% rating, but there was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support the higher 20% meniscal rating.  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 was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.  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 left knee condition.  

BOARD FINDINGS:  In the matter of the left 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.  

AR20190004102, XXXXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXXXX:

	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.

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXXX.