RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02865
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090326

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

CI CONTENTION:  His knee condition has worsened and he 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 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 - 20090112	VARD - 20090609	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Knee Pain…Right Knee	5099-5003	10%	Status Post Medial Meniscus Tear…Repair with Residual Scars	5299-5259	10%	20090415	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI initially injured his right knee prior to service and then reinjured it during a ruck march in November 2007.  An MRI was suspicious for a medial meniscus tear and he underwent an arthroscopic meniscal repair and plica (fold in the joint lining, synovium, with entrapment) excision in April 2008.  His post-operative rehabilitation was complicated by extra-duty incurred in non-judicial punishment and a fall that apparently reinjured the joint.  
During the 3 November 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported ongoing knee pain and the use of a brace.  Physical examination showed a stable but tender knee.  Flexion was to 95 degrees (normal 140) and extension was limited to 5 degrees (normal 0).  No comment was made regarding gait.  

The 22 November 2008 MEB NARSUM examination, 4 months before separation, noted the above history and the CI reported that his knee gave way 3 times a day.  Physical examination showed a stable knee and normal strength but tenderness along the medial joint line.  Range of motion (ROM) measurements performed with a goniometer were limited by pain and showed flexion of 100 degrees and extension of 5 degrees.  

At the 15 April 2009 VA Compensation and Pension (C&P) examination, 3 weeks after separation, the CI reported that he was limited to standing no more than 1 hour and walking no more than 50 meters.  Physical examination showed a normal gait and pain-free flexion of 140 degrees and extension of 0 degrees, with no change with repetitive motion.  The knee was stable and signs of meniscal irritation were absent.  One week later at a state disability evaluation, the CI’s gait was noted as stiff, but he could get on and off the examination table without assistance.  He could perform a full squat “holding on, but did arise slowly.”  The knee was stable with no atrophy and ROM was full; painful motion was not documented.  The joint line was tender both medially and laterally, but specific provocative testing for meniscal irritation was not recorded.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded as 5003 (degenerative arthritis), citing slight loss of motion.  The VA also rated the right knee condition 10%, analogously coded as 5259 (cartilage, semilunar, removal of, symptomatic), based on the C&P examination, citing symptomatic removal of the semilunar cartilage.  A 10% rating is supported by painful, limited motion as noted on the PEB examination, and by a symptomatic meniscectomy.  Neither code (5003 or 5259) offers a rating advantage over the other, nor was any other coding option more advantageous to the CI.  After due deliberation, considering all of 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 right knee pain condition.  

BOARD FINDINGS:  In the matter of the right knee pain 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 20170429, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008227, 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