RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02858
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “left knee pain” with a disability rating of 10% 

CI CONTENTION:  Review all conditions.  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 - 20080523	VARD - 20081114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	Post-Operative Left Knee Arthroscopy 	5010-7101	20%	STR	
Hypertension	Not Unfitting 	Hypertension	7101	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent arthroscopic left knee surgery in November 2007 for medial meniscal debridement and chondroplasty.  He then underwent aspiration and intra-articular steroid injection at the orthopedics clinic on 14 February 2008.  At a follow-up examination on 10 March 2008 there was near full range of motion (ROM) and improved knee pain, but continued moderate effusion.  

During the 20 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported giving out, swelling, and pain in the left knee, with drainage three times since his surgery.  Physical examination revealed decreased flexion without specifics.  An MRI showed moderate osteoarthritis with bony contusion of the medial femoral condyle and medial tibial plateau, probable tear of the medial and lateral menisci, and joint effusion.  

The 29 April 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain with occasional swelling that increased if the CI walked more than a mile.  He denied true instability, but experienced daily give-way secondary to pain.  Additionally, there was some catching, but no locking.  He was unable to run; and prolonged walking, sitting, lifting, carrying weights (40 lbs. max), and sit-ups were painful.  Physical examination noted a slightly antalgic gait and there was mild-to-moderate effusion.  The ROM evaluation showed flexion of 130 degrees (considered by the examiner normal for the CI’s body habitus) with pain beginning at 115 degrees.  Extension was 0 degrees (normal).  The measurements were unchanged after three repetitions.  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%, analogously coded 5099-5003 (arthritis, degenerative), citing degenerative arthritis, verified by arthroscopy with satisfactory evidence of painful motion.  The VA rated the left knee condition 20%, dual coded 5010-5258 (traumatic arthritis - cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint), based on the STR, citing painful limitation of flexion, atrophy, and effusion with additional pain and weakness with repeated motions. 

The persistence of pain after meniscal surgery warranted a 10% rating under code 5259 (cartilage, semilunar, removal of symptomatic), which does not constitute a rating advantage to the CI.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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 therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB available 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.  

Contended PEB Condition:  Hypertension.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is 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 hypertension condition, the panel recommends no change from the PEB determination 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 20170424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180011608, 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