RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02653
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Military Policeman, medically separated for “chronic pain, right knee” with a disability rating of 0%.   

CI CONTENTION:  In addition to the right knee condition, the CI also requested review of 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 Physical Evaluation Board 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 20061106	VARD - 20070823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	0%	[Surgical Residuals] Right Knee 	5003-5260	10%	20070726	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Knee.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent meniscal debridement in May 2004, anterior cruciate ligament reconstruction in October 2005 and autologous chondrocyte implantation in December 2005.  There was ample documentation in post-operative STR provider entries of measured range of motion (ROM), with flexion improving from 98 degrees to 130 degrees (normal 140) and 0 degrees extension (normal).  There were multiple notations of painful motion.  There was STR documentation of a normal gait, and of the absence of persistent effusion, significant instability, or impingement (locking).  There was no STR documentation of more significant ROM limitation or evidence contrary to the above ratable findings.  

The 25 August 2006 MEB NARSUM examination, 4 months prior to separation, documented “moderate occasional” pain without note of subjective instability or locking.  The condition limited prolonged walking and standing, and prohibited running and multiple general soldiering requirements.  The physical examination recorded tenderness and mild anterior laxity (no ratable instability), without note of effusion, impingement or gait disturbance.  Measured ROM was flexion of 130 degrees and 0 degrees of extension, specifying painful motion.  

The 26 July 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, documented non-specific pain, without note of subjective instability or locking, and “significant” occupational impact (prohibited career preference as firefighter).  The physical examination recorded tenderness, a normal gait, and no instability or impingement.  Measured ROM was flexion to 115 degrees and 0 degrees of extension, specifying painful motion but no ROM degradation with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the condition 10%, coded 5003-5260 (degenerative arthritis causing limitation of knee flexion), based on the C&P examination, citing painful motion.

There was no ROM limitation in evidence to support a minimum rating under the applicable codes (5260, 5261).  Members agreed, however, that there was satisfactory evidence of painful motion from both the service and VA examinations to support a minimum 10% rating IAW VASRD §4.59.  It was further noted that code 5259 (cartilage, semilunar, removal of, symptomatic) was applicable to this case, and provides for a 10% rating independent of any other criterion.  There was no evidence of significant instability (5257), frequent locking with recurrent effusions (5258), or fracture, nonunion or malunion of the femur or tibia to support consideration of a higher rating under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There were no other criteria in evidence to support a rating higher than 10% under any applicable VASRD §4.71a code.  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 right knee condition coded 5099-5010 (analogous to arthritis due to trauma).

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5099-5010 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Surgical Residuals, Right Knee	5099-5010	10% 	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170319, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007851, 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.