RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01977
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Paralegal Specialist, medically separated for “arthritis due to trauma, right knee” with a disability rating of 10%.  

CI CONTENTION:  No specific contention made.  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 - 20081210	VARD - 20091016	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arthritis Due to Trauma (Right Knee)	5010	10%	Chondromalacia Patella, Right Knee, Status Post-Surgical Procedures	5260-5010	10%	20090805	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Knee Arthritis Due to Trauma.  According to the service treatment record and the MEB narrative summary (NARSUM), the CI underwent right knee surgery (Fulkerson osteotomy) in 2001 for chondromalacia and did well until right knee pain returned in 2008.  The CI had a second right knee surgery in April 2008 for hardware removal and arthroscopic chondral abrasion of chondromalacia.  At the 24 October 2008 physical therapy (PT) evaluation, the CI complained of abnormal gait, right knee swelling, and decreased range of motion (ROM).  Physical examination showed a non‑antalgic gait.  There was mild right knee effusion with painful ROM of extension to 3 degrees (normal 0) and flexion to 140 degrees (normal 140).  

The 19 November 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of right knee popping and grinding.  Physical examination showed right knee well‑healed scars.  ROM was extension to 0 degrees and flexion to 135 degrees with a sensation of tightness and grinding on full extension.  There was no instability.  

At the 5 August 2009 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported right knee pain with a grinding sensation and occasional episodes of locking up.  Physical examination showed right knee tenderness with a positive patellar grind and crepitus.  ROM was painful with extension to 0 degrees and flexion to 125 degrees, and after repetition there was lack of endurance without change in ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5010 (arthritis due to trauma), citing painful motion.  The VA also rated the right knee condition 10%, dual coded 5260-5010 (leg, limitation of flexion - arthritis due to trauma), based on the C&P examination, citing painful or limited motion of a major joint.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of 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).  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 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 higher rating than 10% available under any applicable VASRD 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 right knee arthritis condition.  

BOARD FINDINGS:  In the matter of the right knee arthritis 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170330, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180008651, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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.

Sincerely,					      
Enclosure