RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02475
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090512

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

CI CONTENTION:  Review of all conditions was requested to include additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090204	VARD - 20090717	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Patellofemoral Syndrome Resulting in Chronic Left Knee Pain…	5099-5003	10%	Left Knee, Status Post Baker’s Cyst Repair	5260	10%	20090226	
Chronic Right Shoulder Pain	Not Unfitting	Right Shoulder Strain	5203	10%	20090226	
Chronic Low Back Pain	Not Unfitting	Lumbar Strain	5237	10%	20090226	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in September 2005 to repair the patellar tendon and meniscus.   At the time of the orthopedic clinic appointment on 17 March 2008, 14 months prior to separation, the CI reported left knee pain.  Physical examination showed an old, well-healed scar.  There was tenderness over the distal pole of the patella.  Left knee range of motion (ROM) was “full."  

During the 24 October 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported ongoing swelling, a burning feeling, and crackling sounds from his left knee.  Physical examination revealed left knee tenderness.  There was no effusion, erythema, edema, ecchymosis, or patellar grind.  Meniscal testing was positive.  Left knee ROM after repetitive motion showed flexion of 145 degrees (normal 140) and extension of 0 degrees (normal).  There was pain with left heel walking.  Left knee X-rays 2 days later revealed medial compartment narrowing.  The patellofemoral joint was within normal limits and the osseous structures were intact.  

The 5 December 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic left knee pain and swelling which increased with activity and flares-ups.  The examiner referenced the 24 October 2008 MEB examination and indicated the CI’s left knee condition was chronic in nature and that there had been no significant change.  

At the 26 February 2009 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported constant burning, sharp left knee pain (8/10) that could be elicited by physical activity.  Physical examination showed a normal gait.  There was left knee tenderness with no signs of edema, effusion, weakness, redness, heat, or guarding of movement.  Meniscus tests were negative.  ROM after repetitive motion showed flexion of 50 degrees and extension of 0 degrees.  Painful motion was noted.  

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 (degenerative arthritis), citing satisfactory evidence of painful motion.  The VA also rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing painful motion of a major joint.  

The panel noted there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261), although the C&P examination approximated the 10% criteria under code 5260.  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), to support a rating under that code.  The analogous 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case but the maximum 10% rating under that code provided no benefit to the CI as it encompasses 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, 5262).  There was therefore no higher rating than the 10% adjudicated by the PEB available under any applicable VASRD 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 left knee condition.  

Contended PEB Conditions:  Chronic Right Shoulder Pain and Chronic Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement and   neither failed retention standards.  There was no performance-based evidence from the record that either of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  
BOARD FINDINGS:  In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended chronic right shoulder and chronic low back conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 20170313, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190006000, 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