RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01918
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Helicopter Repairman, medically separated for “left knee pain” with a disability rating of 0%.  

CI CONTENTION:  “I had reconstruction surgery on my left knee.  My MCL was reattached to my patella with anchors.  I have a 6 inch scar and muscle atrophy and I was only rated on my left knee.  Nothing else was evaluated.”  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 - 20060123	VARD - 20070321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Left Knee Retropatellar Pain Syndrome	5260	0%	20060929	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent left knee surgery in December 2003 with lateral release, reconstruction of the medial patellofemoral ligament and debridement of a medial meniscal tear.  At the time of the orthopedic clinic appointment on 4 October 2005, 6 months prior to separation, the CI reported left knee pain, worse with weight bearing and prolonged sitting.  On examination there was tenderness of the knee and hypersensitivity of the medial patella.  Patella femoral grinding test was positive but there was no swelling, effusion or crepitus of the knee.  The knee was stable and there was full range of motion (ROM).  

The 30 November 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of left knee pain and unpredictable buckling.  Activities that contributed to the pain included prolonged standing, running, jumping and activities in the cold.  Physical examination showed patella tenderness and the patella femoral grinding test was positive, but there was no patella crepitus, swelling or effusion of the left knee.  There was no evidence of knee instability. The goniometric ROM study, after repetition, showed left knee flexion of 125 degrees (normal 140) and extension of 0 degrees (normal).  The CI had mild pain during ROM testing.  

At the 29 September 2006 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported left knee pain with weakness, stiffness, instability and lack of endurance.  Physical examination showed no pain, weakness or tenderness.  Left knee ROM testing showed flexion of 140 degrees and extension of 0 degrees without pain or difficulty.  Provocative testing to elicit meniscal pathology or knee instability was negative. 

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 the US Army Physical Disability Agency pain policy.  The VA also rated the left knee condition 0%, coded 5260 (leg, limitation of flexion of), based on the C&P examination, citing a diagnosis of retropatellar pain syndrome.  

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 limitation of motion and functional loss supporting a 10% rating based on §4.59, §4.40 and §4.45.  The CI also had a history of surgery to remove a meniscus (5259) which supported a 10% rating, but this provided no rating advantage to the CI.  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%, analogously 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 Pain	5099-5003	10%	

[AR Number], XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

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.