RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxx	CASE:  PD-2017-03492
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080924

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

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 - 20080709	VARD - 20081209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Left Knee Osteochondritis Dissecans	5260	10%	20081202	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee arthroscopic surgery in September 2007 for a Grade III chondromalacia including chondroplasty, lateral release and meniscal debridement.  At the time of the physical therapy (PT) clinic appointment on 11 March 2008 the CI reported left knee pain (1/10) that increased with activity or sitting long periods.  On examination the CI’s gait was normal.  He was able to hop, but with pain.  Strength was 5/5 and there was no effusion.  Left knee range of motion (ROM) showed flexion of 115 degrees (normal 140) and extension of 0 degrees (normal).  

During the 21 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported left knee pain.  Physical examination revealed effusion and consistent retropatellar crepitus present with repetitive ROM.  There was retropatellar, infrapatellar and medial side pain after repetitive sit-to-stand testing.  Anterior and posterior drawer, Lachman’s and McMurray’s tests were all negative.  

The same-day MEB NARSUM examination noted complaints of left knee pain in the peripatellar region as well as in the medial aspect of his knee.  He noted painful mechanical symptoms as well as pain in the lateral aspect of his knee.  He noted swelling after prolonged walking and he had significant difficulty with stairs and prolonged sitting.  Physical examination of the left knee revealed well healed surgical incisions.  There was good patellofemoral tracking and the knee alignment was normal with standing.  There was tenderness along the lateral retinaculum and lateral patellar facet.  There was pain with McMurray’s maneuver and tenderness along the medial joint line (meniscal signs).  Anterior and posterior drawer, Lachman’s and varus and valgus tests were all stable.  Distal motor and light touch sensation and vascular examination was intact in the left lower extremity.  Left knee ROM measurements performed by PT on 3 June 2008, 4 months prior to separation, showed flexion of 120 degrees and extension of 0 degrees.  There was no painful motion noted and pain did not cause interference with standing, sitting, or weight bearing of the left knee.  

At the primary care clinic appointment 2 days later, the CI reported left knee baseline pain of 1-2/10.  Flares (5/10) were associated with prolonged standing, or sitting a long time with his left knee flexed, or any kind of long walking.  On examination left quadriceps atrophy was minimal and there were three small arthroscopy scars.  Left knee ROM showed flexion of 120 degrees and extension of 0 degrees after repetition.  He had a moderate amount of retropatellar and peripatellar crepitus.  Painful motion was noted.  Repetitive motion did not cause decrement in the ROM, but it did increase the pain.  It did cause weakness and loss of endurance and a sense of fatigue, but this was not due to neuromuscular disease, but to pain.  There was no instability or incoordination.  

At the 2 December 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant dull pain with occasional sharp pains to his left knee.  Physical examination showed the CI walked with a normal gait and there was crepitus present.  Left knee ROM showed flexion of 130 degrees and extension of 0 degrees.  There was no painful motion, or decrease in ROM following repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5003 (degenerative arthritis), citing painful motion and loss of flexion IAW the US Army Physical Disability Agency pain policy.  The VA also rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing pain on use.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45).  There was alternatively history of meniscal surgery (5259) to support a rating under that code.  The panel considered other VASRD knee and analogous codes, but all were less applicable and not advantageous for rating.  There was therefore no higher rating than 10% under any applicable VASRD 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.  

BOARD FINDINGS:  In the matter of the left 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.  

AR20190011631,

Dear XXXXXXXXXXXXXXXX:

	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.