RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02105
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080901

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “left knee pain” with a disability rating of 10% 

CI CONTENTION:  “My left knee has never recovered from the original injury.  I’ve been told by multiple doctors that I will need a total knee replacement.”  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 - 20080507	VARD - 20100123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	Left Knee Dislocation	5260-5259	10%	20090903	
			Residual Left Knee Scar	7805	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a left knee arthroscopy with a lateral reticular release on 8 December 2005.  He continued to be symptomatic and underwent a left knee medial capsular reefing (reduction in tissue and securing with sutures) with resection of the medial synovial plica (an extension of the synovial capsule of the knee) on 14 September 2006.  Postoperatively, he underwent physical therapy; however, he continued to have pain and patella dislocations resulting in further surgery including a Fulkerson osteotomy with a medial capsular reefing in March 2007.  An MRI performed on 31 October 2007 was remarkable for findings consistent with minimal chondromalacia (cartilage degeneration) of the patella as well as post-operative tibial osteotomy and lateral retinacular release changes.  He underwent an additional arthroscopy on 11 January 2008 with open lateral release of the patellar retinaculum.  Despite the surgical procedures and physical therapy, the CI continued to have pain, swelling and subluxation of his patella at least once or twice a day.

During the 18 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI had abnormal mobility of the left patella (not tracking).  A mild effusion was noted with pain along the medial and lateral articular lines.  There was no laxity or evidence of a meniscal tear.  Flexion was 100 degrees (normal 140), but physical therapy range of motion (ROM) measurements the same day showed left knee flexion of 130 degrees without reported painful motion.    

The 20 March 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of moderate, sharp and constant pain with swelling and subluxation of the patella.  Physical examination showed a moderate sized effusion and the CI had diffuse tenderness.  Active ROM was 5 degrees extension (normal 0) to 95 degrees of flexion.  He had a positive patellar apprehension test.    

At the 3 September 2009 VA Compensation and Pension (C&P) evaluation, 12 months after separation, the CI reported daily pain, weakness, stiffness and swelling when it rained,  but no heat or redness.  There was occasional instability or giving way, but no fatigability or lack of endurance.  The CI reported additional episodes of dislocation or recurrent subluxation since his last surgery.  The examiner found objective evidence of painful motion and tenderness with no edema, effusion, instability, weakness, redness, heat, abnormal movement or guarding of movement of the left knee.  Flexion was 140 degrees with pain and extension was 0 degrees with pain.  Joint motion was not limited by repetition.  There was no laxity or instability, although the McMurray’s test (to determine a meniscal tear) was positive.  X-rays of the left knee were unremarkable with metallic screws overlying the proximal tibia were positioned properly.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion of one joint.  The VA rated the left knee condition 10%, dual coded 5260-5259 (leg, limitation of flexion of--cartilage, semilunar, removal of, symptomatic), based on the C&P examination, citing painful motion.  

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 VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code.   After due deliberation, considering all of 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170401, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008188, 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