RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02838
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20091123

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 “cartilage, semilunar, removal of, left knee” with a disability rating of 10%.  

CI CONTENTION:  If surgery had been done he could have stayed in the Army.  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 - 20091002	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthropathy Left Knee
	5259	10%	No VA Examination Proximate to Separation in Evidence	
			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Cartilage, Semilunar, Removal of, Referred to as Osteoarthropathy Left Knee.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee arthroscopic surgery on 19 June 2008, which included a medial femoral condyle chondroplasty (cartilage removal/repair) and partial medial meniscectomy.  An MRI on 6 December 2008 indicated a torn posterior horn of the medial meniscus.  There was a moderate joint effusion with an intact quadriceps tendon and patellar ligament.  An MRI on 13 February 2009, 8 months post-surgery and 9 months prior to separation, showed marked osteoarthropathy of the left knee isolated to the medial compartment.  Weight bearing X-rays of the left knee on 3 March 2009 were normal.  There was no evidence of a joint effusion or significant arthritic change and the joint spaces were adequately maintained.  At the primary care clinic visit on 28 April 2009, 10 months post-surgery and 7 months prior to separation, the CI complained of left knee pain but was not in any acute distress.  Examination showed an effusion, but full pain-free range of motion (ROM).  There was no instability or tenderness, and McMurray’s test was negative.   

During the 6 August 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported use of an off-loader brace.  Physical examination showed full ROM with an effusion.  There was medial joint line tenderness without instability or deformity.  The 18 August 2009 MEB NARSUM examination, 2 weeks later, noted complaints of severe left knee pain with running, rucking, or prolonged standing.  He denied radiating pain or locking of the left knee, but indicated instability.  Physical examination showed full ROM without effusion, instability, or deformity.  There was positive medial joint line tenderness, but negative McMurray test.  Provocative testing to elicit laxity or instability was negative.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, coded 5259 (cartilage, semilunar, removal of, symptomatic), citing functional loss due to factors such as pain, including pain on repeated use and painful motion, fatigability, incoordination, weakness with repetitive use, and flare-ups.  The persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code.  There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  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 no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  Therefore, there was 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 20170413, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008724, 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