RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02299
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090127

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

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 - 20081105	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Right Knee…	5003	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Right Knee Degenerative Arthritis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in early 2005 after twisting the knee following a fence climb and subsequent fall.  MRI of the right knee on 20 July 2007, 18 months prior to separation, revealed a normal study.  

At the physical therapy clinic appointment on 4 January 2008, 13 months prior to separation, the CI reported right knee pain with walking long distances and lifting.  On examination, the CI walked with an antalgic gait and right knee strength was 4/5.  Right knee range of motion (ROM) showed flexion of 130 degrees (normal 140) and extension of 3 degrees (normal 0) with pain at end of range.  

During the 23 April 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported chronic right knee pain with giving out, popping, and sometimes locking.  Physical examination revealed strength was 5/5 and the CI ambulated with a cane and an antalgic gait.  Right knee ROM showed decreased extension with painful motion.  

The 15 July 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of chronic right knee pain (4/10) with daily flare-ups that exacerbated to 8/10.  Exacerbating factors included prolonged walking and walking on uneven surfaces.  Physical examination revealed the CI walked ambulated with the use of a cane and strength was 5/5.  Pain was elicited with knee flexion and extension at the extremes of ROM.  McMurray’s test (tear of the meniscus) was positive on the lateral aspect of the knee.  

At the 21 October 2008 follow-up MEB NARSUM examination, 3 months prior to separation, the CI reported chronic right knee pain.  On examination, McMurray’s test laterally was positive.  Right knee ROM showed flexion of 114 degrees and extension of 0 degrees.  Pain was elicited by flexion and extension.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5003 (degenerative arthritis), citing limitation of motion of one major joint, including consideration of functional loss (VASRD §§4.10, 4.40, 4.45 and 5.69).  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 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 condition.  

BOARD FINDINGS:  In the matter of the right 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 20170222, w/atchs  
Exhibit B.  Service Treatment Record  

AR20190007573, 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