RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-01797
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Human Intelligence Collector, medically separated for a “left knee injury” with a disability rating of 0%.  

CI CONTENTION:  Review 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 - 20070723	VARD - 20071207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Injury	5099-5003	0%	Left Knee Condition	5299-5260	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Knee Injury.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee was evaluated for patellofemoral syndrome in October 2005 during basic training.  Knee symptoms resolved but in December 2005 she stepped in a pothole during physical training, twisted her left knee and fell.  X-rays and MRIs were normal.  Orthopedics reviewed the findings and found no surgical indications.  Despite conservative therapy with pain medication, physical therapy and temporary profiles, pain persisted.  

The 15 May 2007 MEB NARSUM examination, 7 months prior to separation, noted complaints of left knee pain.  Physical examination showed mild tenderness about the lateral and inferior patellar margins.  There was significant point tenderness at the mid and posterior lateral joint line.  Provocative testing showed equivocal meniscal pathology, but the left knee was ligamentously stable and X-rays were unremarkable.  Left knee range of motion (ROM) testing by physical therapy (PT) on 22 May 2007, showed flexion of 114 degrees (normal 140) and hyperextension of 4 degrees (normal 0), after repetitive motion.  Painful motion was noted.  

At the 23 October 2007 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported left knee weakness, stiffness, giving way, lack of endurance, locking and 7/10 pain, elicited by physical activity.  Physical examination showed a normal gait and left knee without edema, effusion, weakness, tenderness, redness, heat or abnormal movement.  There was no evidence of recurrent subluxation, locking pain, joint effusion or crepitus.  Left knee ROM testing showed flexion of 140 degrees and extension of 0 degrees.  Provocative testing for left knee instability or meniscal pathology was negative.  Pain, weakness, lack of endurance, fatigue or incoordination did not impact ROM after repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5003 (arthritis, degenerative), citing minimal and intermittent pain IAW the US Army Physical Disability Agency pain policy.  The VA did not service connect the left knee condition, analogously coded 5260 (leg, limitation of flexion of), based on the STR, citing medical evidence of record failed to show that such a condition currently exists.  

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) or history of surgery to remove a meniscus (5259) to support a rating under those codes.  There was no fracture, nonunion or mal union of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  However, the MEB physical therapy examination showed 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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left knee condition, 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	
Left Knee Injury	5099-5003	10%	

AR20190007023, 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.