RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxxx	CASE:  PD-2017-03034
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060409

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E7, Combat Engineer, medically separated for “right knee pain” with a disability rating of 0%.  

CI CONTENTION:  No specific contention was made.  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 - 20060302	VARD - 20070313	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Status Post Right Knee Chondroplasty and Osteochondral Graft	5257	20%	20060727	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee pain began with a fall on his right knee in February 2004 which resulted in a traumatic anterior cruciate ligament (ACL) and meniscus tear.  In March 2004, the CI underwent debridement and in May 2004 he underwent hamstring ACL repair.  He experienced subsequent infections and on 21 September 2005 he underwent a partial synovectomy and osteochondral transplant, but continued to have knee pain.  

The 22 December 2005 orthopedic physical examination revealed right knee generalized effusion with flexion at 125 degrees (normal 140) and extension at 0 degrees (normal).  No comment was made regarding painful motion.  The 25 January 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic right knee pain aggravated by walking, jumping and running.  Physical examination revealed the CI’s gait favored the right knee.  There was no effusion or erythema.  Lachman and anterior drawer sign were negative and the knee was stable to varus and valgus.  There was considerable quadriceps atrophy (quadriceps circumference at 15 cm is 53 cm on right and 56 cm on the left).  Range of motion (ROM) from 9 December 2005 showed flexion of 119 degrees and extension of 2 degrees, with painful motion at 125 degrees of passive motion.  

At the 27 July 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported marked right knee pain with a grinding sensation.  Physical examination showed guarding of the right knee.  There was no deformity, edema, effusion, or redness, although heat was noted over entire knee.  There was pain on palpation over the medial joint line.  Anterior drawer sign was positive at 1 cm and Lachman test was negative.  McMurray’s test (meniscal) was negative, but with prominent crepitation.  There was patellar laxity of 2 cm without crepitation.  ROM was flexion at 105 degrees and extension at 0 degrees, with no pain, no change on repetition, and ROM was symmetric to the opposite knee.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis) citing full ROM without joint instability, and rated for pain – slight intermittent (with likely application of the US Army Physical Disability Agency pain policy).  The VA rated the right knee condition 20%, coded 5257 (knee, other impairment) based on the C&P examination, citing recurrent subluxation or lateral instability of the knee which is moderate.  

There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, the persistence of pain after meniscal surgery warranted a 10% rating under the 5259 code (cartilage, semilunar, removal of symptomatic).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a higher 20% rating under that code.  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).  Alternative/additional rating for instability was not within the PDBR scope.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the chronic right knee pain, coded 5299-5259.  

BOARD FINDINGS:  In the matter of the chronic right knee condition, the panel recommends a disability rating of 10%, analogous coded 5299-5259 IAW VASRD §4.71.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Knee Pain	5299-5259	10%	

The following documentary evidence was considered:

[AR NUMBER], 

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Enclosure