RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02811
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “posttraumatic patellofemoral arthritis, left knee” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions” as well as 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 - 20050418	VARD - 20060515	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Patellofemoral Arthritis, Left Knee	5010	10%	Post Traumatic Patellofemoral Arthritis, Left Knee…	5010-5259	10%	20060329	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Knee Posttraumatic Patellofemoral Arthritis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent reconstruction of the left anterior cruciate ligament with patellar tendon autograft and an arthroscopic partial medial meniscectomy in January 2004.   The 12 January 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of nagging knee pain with some popping.  He experienced pain when descending stairs and walking, and could stand for up to 90 minutes before he had to sit down.  He was unable to run, but took no medicine for pain.  Physical examination showed an antalgic gait, some femoral medial joint line tenderness, and pain with patellofemoral compression.  Lachman's testing was negative for instability as were varus, valgus and drawer tests. Range of motion (ROM) revealed flexion to 120 degrees (normal 140) and extension to 0 degrees (normal).  During the 28 March 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months before separation, the examiner noted tenderness, full ROM, and pain with standing up from a deep knee bend.    

At the 29 March 2006 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported use of a hinged left knee brace after painful, semi-weekly flare-ups.  Swelling was noted to improve with heat and elevation, and he denied locking of the knee joint, heat, or redness.  Endurance and strength were not diminished in the absence of pain or swelling. The examiner referred to an MRI from 5 December 2005 which revealed surgical changes of the left knee with the medial meniscus anteriorly and posteriorly showing decreased sizes. There was also evidence of free fluid in the patella-femoral space.  Physical examination showed left knee active flexion of 130 degrees and extension of 0 degrees, and no additional limitation due to pain, fatigue, weakness, lack of endurance or incoordination after repetition.  Crepitance was noted on repetition and stress during left knee extension.  A non-reproducible click was felt with the first McMurray test, but drawer testing was negative collateral ligaments were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5010 (traumatic arthritis).  The VA also rated the left knee condition 10%, but dual coded 5010-5259 (traumatic arthritis-cartilage, semilunar, removal of, symptomatic), based on the C&P examination, citing limitation of motion.  Panel members agreed there was no limitation of flexion or extension  (5260, 5261), and no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support ratings under those respective codes.  Additionally, 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).  While the persistence of pain after meniscal surgery warranted a 10% rating under code 5259, this provided no benefit to the CI.  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 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 20170328, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007192, 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.