RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02231
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “left anterior knee pain” 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 - 20051118	VARD - 20060719	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Anterior Knee Pain	5099-5003	0%	Chondromalacia Patella, Left Knee	5014	10%	20060505	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Left Anterior Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in approximately April 2003 while running.  Examination on 15 December 2004 revealed a full range of motion (ROM) with patellar crepitus (grinding sensation), but no swelling, edema or instability.  Left knee X-rays noted irregularity of the kneecap and proximal medial tibia and an MRI demonstrated patellar chondromalacia (cartilage degeneration) medially along with a small joint effusion.  

At a primary care clinic visit on 28 April 2005, examination of the left knee revealed full ROM without an effusion but with some crepitus “deep to patella.”  On 26 May 2005, the CI reported wearing a knee band to keep the patella in place.  On examination, pain was elicited at the extreme limits of ROM and by motion using Noble’s compression test (to determine iliotibial band syndrome).  

During the 6 June 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported wear of a knee band to help support his knee.  Physical examination revealed crepitus of the left knee with no swelling.  There was tenderness of the proximal medial tibia radiating down the inner leg.  

The 19 July 2005 MEB NARSUM examination, 8 months prior to separation, noted complaints of continued and worsening left knee pain affecting his ability to run or be on his knees for a long time.  Physical examination showed full active ROM of the left knee. There was no tenderness and provocative testing to elicit meniscal pathology or knee laxity was negative.  He had a positive patellar grind test, but no joint line tenderness and good ligament stability.  There was no swelling or erythema, and neurovascular status was intact with good capillary refill and normal sensation.  

At the 5 May 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported knee pain with stair climbing and walking uphill.  The knee did not lock or give way.  He was able to run about 50 meters before he developed knee pain and had to stop.  He denied knee incapacitation and reported no spontaneous flare-ups.  Physical examination showed crepitus and a positive patella apprehension test (to determine subluxation or dislocation of the patella), but no ligamentous laxity or instability, inflammation, redness, swelling or pain of the left knee.  Active ROM evaluation showed flexion of 130 degrees (normal 140) at which point he had some discomfort and extension was normal at 0 degrees.  There was no change in ROM after repetition and no additional loss of ROM due to pain, weakness, impaired endurance, fatigue, incoordination, or flare-ups.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing slight, occasional pain.  The VA rated the left knee condition 10%, coded 5014 (osteomalacia), based on the C&P examination, citing patellar crepitus and a positive apprehension test.

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 patellar crepitus, a positive apprehension test and pain at the end of flexion causing functional loss, which supported a 10% rating based on VASRD §§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).  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, analogously coded 5099-5003.  

Contended PEB Condition:  Diabetes.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Although the condition was profiled (P2), it was not explicitly implicated in the commander’s statement or judged to fail retention standards.  The CI was first evaluated for diabetes in 2005 and treated with Glucophage (metformin).  He closely monitored and controlled his diet and weight.  Hemoglobin A1C was 6.1% (normal is less than 5.7%) and his average glucose readings at home were around 142 mg/dL (normal is less than 100 mg/dL) with no low readings.  His diabetes appeared to be well-controlled and he had good compliance with medical therapy.  Although he had hyperlipidemia, there was no retinopathy, history of diabetic ketoacidosis, or albuminuria (protein in the urine).  The panel could find no performance-based evidence from the record that showed how the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

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.  In the matter of the contended diabetes, the panel recommends no change from the PEB determination as not unfitting. 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 Left Anterior Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010653, 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.

Sincerely,					      
Enclosure