RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03460
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080213

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

CI CONTENTION:  No specific contention 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 - 20071209	VARD - 20080416	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Degenerative Joint Disease and Disruption of ACL, Right Knee	5260-5003	10%	20070417	
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 debridement of a medial meniscus tear in 1999, and he slipped and re-injured his right knee while playing soccer in July 2006.  Right knee X-rays showed mild to moderate degenerative arthritis and most likely a Segond fracture usually associated with ligamentous and meniscal injury.  An MRI revealed significant meniscal pathology involving both medial and lateral menisci, a possible loose osteochondral body within the patellofemoral joint space, chondromalacia patella, an osteochondral injury of the posterolateral femoral condyle, and disruption of the anterior cruciate ligament (ACL).  On 13 May 2007 the CI underwent arthroscopy that revealed evidence of prior surgery.  He had grade 4 chondromalacia on the lateral anterior femoral condyle, no meniscus in the medial compartment, and a small posterior horn remnant of meniscus.  There were grade 2 changes on the posterior tibial plateau and on the medial femoral condyle.  The ACL medial bundle was torn and scarred to the posterior cruciate ligament, and an osteochondral defect of the lateral femoral condyle was present.  Debridement of impinging synovium (membranous covering of the joint) and microfracture chondroplasty of the lateral femoral condyle were performed.  

During the 12 September 2007 MEB NARSUM examination, 5 months prior to separation, the CI stated that he had difficulty running and enjoying recreational sports, climbing ladders, walking, standing, or sitting for long periods of time.  Pain was frequent, but severity was slight.  Physical examination showed no laxity with negative findings for varus/valgus stress, Lachman’s, pivot, and dial tests.  Pain was present at the lateral and medial joint lines and the anteromedial and the anterolateral joints.  His patella had minimal grinding and no apprehension.  Right knee range of motion (ROM) testing showed flexion of 120 degrees (normal 140) and extension of 0 degrees (normal).  At the 19 September 2007 physical therapy appointment the CI complained of retropatellar knee pain with a severity of 4/10.  Examination showed a normal gait and no tenderness.  ROM showed flexion of 130 degrees and extension of 5 degrees.  

At the 16 January 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported daily right knee pain, swelling, and decreased ROM.  Physical examination showed a normal gait with no ambulatory aids and no tenderness.  There was a positive anterior drawer test with a good end-point and Lachman’s test was negative.  McMurray’s test (to determine a meniscal tear) was negative.  The ROM study noted crepitus with ROM testing with flexion of 140 degrees and extension of 0 degrees.  There was no limitation due to pain, fatigue, weakness, or lack of endurance with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 10%, analogously coded 5099-5003 (degenerative arthritis).  The VA also rated the knee condition 10%, coded 5260-5003 (leg, limitation of motion-arthritis, degenerative) based on the C&P examination, citing painful or limited motion of a major joint with X-ray evidence of arthritis.  

The panel agreed 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) to support a rating under that code.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case, but the maximum 10% rating under that code provided no benefit to the CI.  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).  Therefore, there was 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 right knee 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.  

AR20180015346, 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.