RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03259
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E3, Motor Transport Operator, medically separated for “chronic pain, right knee” with a disability rating of 10%.  

CI CONTENTION:  Her knee condition continues to worsen and negatively impact daily activities.  She also 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 - 20051006	VARD - 20061120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	10%	Patellofemoral Syndrome (PFS), Right Knee, Status-Post Arthroscopy	5099-5019	0%	20060726	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee arthroscopic surgery in November 2004 for patellofemoral chondromalacia.  The procedure included debridement of an inflamed medial synovial plica and infrapatellar fat pad.  An MRI from August 2004 had shown medial meniscus degenerative changes and non-specific bone bruising superior to the tibial tuberosity.  

At the 1 February 2005 physical therapy (PT) clinic visit, 2 months after surgery and 10 months before separation, the CI reported right knee pain rated at 5/10 before therapy session and 7-8/10 pain afterwards.  The provider noted use of a cane despite repeated instruction to progress off assistive devices.  She had varying degrees of right antalgia, but was able to ambulate on a treadmill with the speed set at 2.2 for 8-12 minutes with no antalgia.  She demonstrated the ability to ascend/descend steps reciprocally, and while she reported being able to walk for only 20 minutes, she also stated she could shop for 1-2 hours at a time.  Right knee range of motion (ROM) was 0-130 degrees (0-140 normal) with no crepitus or abnormal patellar glide.  The therapist noted that all ROM, strength, edema, and gait goals had been met.  However, the CI continued to experience right knee pain that precluded her return to full duty.  

At the 30 August 2005 MEB NARSUM examination, 3 months prior to separation, the CI reported she was unable to run, sit more than 20-30 minutes, walk for more than 10 minutes, or drive longer than 20-30 minutes.  Physical examination repeated results of a 24 March 2005 rheumatology examination that showed full ROM in all joints and exquisite kneecap tenderness. 

At the 26 July 2006 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported pain rated at 8/10, which occurred 3 times a day and lasted for 2 hours each time.  She had weakness, giving way, locking, fatigability, and dislocation with climbing, as well as stiffness, swelling, and heat from overuse.  She was unable to run at all or stand/walk more than 30 minutes.  The provider noted an abnormal, limping gait and that the CI required a brace to keep her kneecap in place for ambulation.  The right knee showed no signs of edema, effusion, weakness, tenderness, redness, or heat, and there was no abnormal or guarding movement.  Knee ROM was full without painful motion, and repetition did not cause additional limitation due to pain, fatigue, weakness, lack of endurance, or incoordination.  Anterior and posterior cruciate ligament and medial and lateral collateral ligament stability tests were all within normal limits, as were medial and lateral meniscus tests.  Right knee X-rays were normal.  

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 and constant pain in accordance with the US Army Physical Disability Agency pain policy.  The VA rated the right knee condition 0%, analogously coded as 5019 (bursitis), based on the C&P examination, citing no evidence of criteria meeting a higher rating for painful or limited motion, recurrent subluxation or lateral instability, malunion of the tibia with slight symptomatology, or genu recurvatum.  Members agreed there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261); or history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); or history of surgery to remove a meniscus (5259) to support a rating under those codes.  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 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 right knee condition.  

BOARD FINDINGS:  In the matter of the chronic right knee pain 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 20170404, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180012274, 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