RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02373
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “chronic left knee pain” 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 - 20081208	VARD - 20090619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5003-5099-5262	10%	Left Knee Strain	5260	0%	20090221	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee arthroscopic surgery in September 2007 to remove loose bodies and medial meniscus.  She subsequently underwent surgery in March 2008 to repair a new meniscal tear.  She reinjured her left knee in June 2008 after being dropped from a stretcher during physical training.  

The 19 August 2008 MEB NARSUM examination, 6 months prior to separation, showed left knee tenderness.  Range of motion (ROM) was not quantified but painful motion was elicited with flexion and extension.  

At the 10 September 2008 VA Compensation and Pension (C&P) evaluation, 5 months before separation, the CI reported left knee pain and swelling aggravated by lifting, prolonged standing and weather changes.  Physical examination showed left knee flexion of 130 degrees (normal 140) and extension of 0 degrees (normal), painful motion was present.  Repetition did not reduce ROM and meniscal signs were negative.  

The 8 October 2008 MEB physical therapy ROM study, 4 months prior to separation, showed left knee flexion to 62 degrees and extension to 10 degrees (lacking 10 degrees), with painful motion.  
During the 21 February 2009 C&P evaluation, less than 1 month before separation, the CI complained of left knee pain and stiffness.  Physical examination showed bilateral knee flexion at 120 degrees, full extension and no painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003-5261 (arthritis, degenerative-leg, limitation of extension), citing flexion of 62 degrees and extension limited to 10 degrees.  The VA rated the left knee condition 0%, coded 5260 (leg, limitation of flexion).  

The panel agreed a 10% rating was warranted for left knee extension limited to 10 degrees under code (5261).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  The limitation of flexion (5260) did not support a compensable rating.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under that code.  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 higher rating than 10% available under any applicable VASRD 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 20170413, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008665, 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