RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02331
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20070714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Mortuary Affairs Specialist, medically separated for “chronic right knee pain” with a disability rating of 10%.  

CI CONTENTION:  The condition continues to worsen.  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 - 20070522	VARD - 20080212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5299-5259	10%	Patellofemoral Syndrome	5020	10%	20070913	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery in May 2006 for excision of a lipoma (fatty tumor) and in November 2006 for scope debridement of a plica (folded membrane).  At the 24 January 2007 MEB NARSUM examination, 6 months prior to separation, she complained of right knee pain.  Physical examination revealed tenderness, mild effusion, full range of motion (ROM), and no joint laxity.  At the 13 March 2007 physical therapy appointment, 4 months after the second surgery and 4 months prior to separation, the CI reported right knee pain rated at 6/10.  Measured ROM after repetition showed flexion of 117 degrees (normal 140) and extension of 5 degrees (normal 0) with painful motion.  X-ray studies on 7 May 2007 showed mild lateral patellar tilt but all bones were intact and joints demonstrated normal spacing and alignment; there were no suspicious lesions or significant soft tissue abnormalities.  

At the 13 September 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI complained of constant right knee pain that interfered with standing and walking.  Physical examination revealed mild crepitus, tenderness, no joint deformity or instability, and a non-tender, non-adherent scar.  Measured ROM was painful, with flexion of 110 degrees and extension of 0 degrees, but no additional limitation after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5299-5259 (cartilage, semilunar, removal of, symptomatic), citing normal ROM, no evidence of laxity, but some tenderness along the kneecap.  The VA also rated the right knee condition 10%, coded 5020 (synovitis), based on the C&P evaluation, citing painful or limited motion of a major joint.  Members noted there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260 or 5261).  However, the persistent presence of painful motion in both pre- and post- separation examinations warranted a 10% rating under VASRD §4.59 (painful motion).  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 or 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’s 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 there be 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 20170104, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180005909, 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