[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 and to the counsel you listed on your application, XXXXXXXXXX, VSO, PA Department of Military and Veterans Affairs, Bldg 0-47, Fort Indiantown Gap, Annville, PA 17003-5002.

Sincerely,					      
Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX  	CASE:  PD-2017-02031
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “chronic right knee pain” with a disability rating of 0%.

CI CONTENTION:  No specific contention was 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 - 20060518	VARD - 20070906	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Patellofemoral Pain Syndrome, Right Knee	5099-5014	10%	20070507	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in the 1988-1989 timeframe after falling while cross-country skiing.  The right knee was reinjured again in 1998 and 2002 while running during physical fitness testing.  Surgery was not recommended.

The 13 September 2005 MEB NARSUM examination, 8 months prior to separation, noted complaints of almost daily right knee pain with popping, cracking while lock-up or ‘give way’ occurred one to two times a week.  Physical examination showed a normal tandem and heel and toe walk.  There was right knee tenderness and crepitus without erythema or effusion.  Goniometric-measured repetitive right knee flexion was 111 degrees (normal 140) and extension -1 degrees (normal 0) with painful motion.  

At the 7 May 2007 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported right knee morning pain that increased as the day progressed with occasional swelling and giving way.  He wore a right knee brace.  Physical examination showed a normal gait and station along with right patella tenderness and retro-patellar crepitation.  There was no deformity, instability or atrophy.  Muscle strength and peripheral pulses were intact.  Repetitive right knee flexion was 140 degrees and extension 0 degrees with painful motion. 

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 (degenerative arthritis), citing full range of motion and no instability.  The VA rated the right knee condition 10%, analogously coded 5099-5014 (osteomalacia), based on the C&P examination, citing painful motion.

The panel agreed there was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes 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 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 sufficient evidence of painful motion with functional loss to support 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 right knee condition, coded 5299-5260.

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5299-5260 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	5299-5260	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160307, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record