RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX  	CASE:  PD-2017-03020
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050713

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Internment/Resettlement Specialist, medically separated for “chronic left knee pain” with a disability rating of 10%.  

CI CONTENTION:  “The only issues considered dealt with my left knee…Ten other conditions were never listed in my board.” Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) or 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 - 20050602	VARD - 20051223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Residuals ACL Reconstruction and Meniscal Repair, Left Knee	5010	10%	20051121	
Mild Chronic Mid Back Pain	Not Unfitting	Degenerative Osteoarthritic Changes Lumbosacral and Thoracic Spine	5242	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY: 

Chronic Left Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery in September 2004 for an anterior cruciate ligament (ACL) reconstruction and medial meniscal debridement and repair.  At the 21 April 2005 MEB NARSUM examination, 3 months prior to separation, the CI’s chief complaint included left knee pain that was aggravated with prolonged walking, kneeling or maneuvering stairs.  The left knee-focused physical examination was detailed and completely normal except for medial joint line tenderness and flexion to 135 degrees (normal 140).  

At the 21 November 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported a sharp shooting pain in the left knee with numbness and tingling.  The PE revealed tenderness about the left knee.  Range of motion (ROM) noted normal extension and flexion to 110 degrees.  There was no evidence of weakness, fatigue, or lack of endurance with repetitive motion.

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 (degenerative arthritis), citing full range of knee motion without joint instability, with slight and frequent pain with strenuous activities being the limiting factor.  The VA also rated the left knee condition 10%, coded 5010 (arthritis, due to trauma, substantiated by X-ray findings), based on the STR and C&P examination, citing recurrent subluxation or lateral instability of the knee, which was slight.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261), nor was there evidence of painful motion of the knee joint in support of VASRD §4.59 (painful motion).  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).  Although there was tenderness about the left knee, painful motion was not in evidence.  Panel members agreed that no greater than a 10% rating under VASRD code 5259 (cartilage, semilunar, removal of, symptomatic) was supported by means of historical surgical debridement and repair of the left medial meniscus.  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any other 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:  Mild Chronic Mid Back Pain.  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 or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at or near 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 mid-back condition, the panel agrees it cannot recommend it for additional disability rating.  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:
	PD-2017-03020

[AR NUMBER], XXXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXX

	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.

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Enclosure

	PD-2017-03020