RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03521
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060903

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Air Traffic Control Operator, medically separated for “chronic pain, right knee” with a disability rating of 0%.  

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 - 20060705	VARD - 20080116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	0%	Right Knee Patellar Chondromalacia	5024-5260	10%	20070920	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Knee.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right knee condition began in November 1998 when he injured the knee during a run.  The pain resolved until he sustained a hyperextension injury playing basketball in October 2003.  An MRI from May 2004 showed a questionable cartilage defect along the lateral facet of the posterior patella and no other defects.  An orthopedic evaluation in August 2004 led to a diagnosis of patellar chondromalacia.  He underwent arthroscopy on 29 September 2004, with lateral patellar facet chondromalacia noted and shaved, with no findings of meniscal or ligamentous injury.  
At the time of his 7 March 2006 orthopedic clinic appointment, 6 months before separation, the examiner reported normal alignment of the right knee with no effusion.  There was tenderness along the medial plica, pain medially with full flexion, palpable crepitus on range of motion (ROM), and positive grind.  The Lachman and drawer tests were negative for laxity, and there was no varus or valgus instability.  The physical findings were repeated at the 3 April 2006 orthopedic clinic appointment, 5 months before separation.  Follow-up notes documented that by May 2006 the CI was prescribed and using a knee brace.  

The 8 July 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of constant right knee pain, aggravated with prolonged walking over one mile or walking on uneven terrain.  The CI reported popping but no locking, and there was no mention of giving way.  Physical examination showed normal alignment with no evidence of effusion.  ROM of the right knee, measured by goniometer, revealed flexion of 130 degrees (140 normal) and extension of 0 degrees (normal) without mention of painful motion.  The examiner reported a positive grind test, tenderness along the lateral aspect of the patella and medial joint line, and pain with McMurray testing.  He had negative Lachman and drawer tests, no varus or valgus instability, and normal strength and sensation in the lower extremity.  

At the 20 September 2007 VA Compensation and Pension (C&P) examination, just over a year after separation, the CI reported daily, mild right knee pain with no instability or locking.  He reported flare-ups which occurred about once a month lasting a week, brought on by prolonged walking and carrying heavy objects.  Physical examination showed a normal gait and no tenderness or swelling.  The examiner recorded full ROM which was reported as flexion of 135 degrees (limited by body habitus and ROM the same as the left knee) and extension of 0 degrees with mild pain.  All ligaments were reported as stable, and McMurray test was negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing no ratable limitation of motion.  The VA rated the right knee condition 10%, dual coded 5024-5260 (tenosynovitis – limitation of flexion of the leg), based on the C&P examination, citing pain during extension.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  There was no 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).  However, there was evidence of painful motion on the orthopedic and VA examinations with functional loss supporting a 10% rating (based on §§4.59, 4.40, and 4.45).  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 right knee condition, coded 5299-5260.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5299-5260 IAW VASRD §4.71a.  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 Pain, Right Knee	5299-5260	10%	

AR20180015362, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

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.