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Dear XXXXXXXXXX:

	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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03528
BRANCH OF SERVICE:  army	SEPARATION DATE:  20081215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Calvary Scout, medically separated for “left knee pain” with a disability rating of 10%.

CI CONTENTION:  “Increasing weakness and soreness in the left knee.  Shoulder has been growing weaker gradually.  My work is physically laborious.”  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 - 20080917	VARD - 20060222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	10%	Left Knee Degenerative Changes	5010-5261	10%	20100106	
Mild Degenerative Changes Left Acromioclavicular Joint	Not Unfitting	Left Shoulder Degenerative Changes	5010	10%	20100106	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Left Knee Pain.  According to the MEB NARSUM and service treatment record the CI underwent left knee surgery in 1998 and March 2007 with patellar tendon debridement.  A post-surgical MRI in April 2008 showed left knee patellar ligament thickening.  The 9 May 2008 physical therapy examination showed a normal gait and “full,” but painful, left knee range of motion (ROM). 

During the 28 July 2008 MEB NARSUM examination the CI reported left knee pain.  Physical examination showed normal gait, reflexes and strength.  Left knee ROM was flexion of 140 degrees (normal) and extension of 0 degrees (normal).  Painful motion was not addressed and meniscal testing was negative.   

At the 6 October 2010 VA Compensation & Pension (C&P) examination, 13 months after separation, the CI reported daily left knee pain that became worse throughout the day.  Physical examination revealed a normal gait and no swelling.  The ROM study showed flexion of 140 degrees and extension of 0 degrees, with crepitus and painful motion on repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion.  The VA also rated the left knee condition 10%, dual coded 5010-5261 (arthritis, due to trauma - leg, limitation of extension) based on the C&P examination, citing painful motion.  The panel agreed there was no evidence of limitation of motion (5260, 5261) to support a 10% rating; however, there was sufficient evidence of painful motion, IAW VASRD §4.59, to support a 10% rating.  There was no history of meniscal surgery (5259), no evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  There was no fracture, nonunion or malunion of the femur or tibia causing knee impairment (5255, 5262) to support a higher rating under those codes.  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.

Contended PEB Condition:  Mild Degenerative Changes Left Acromioclavicular Joint.  The panel’s main charge is to assess the fairness of the PEB determination that the contended left shoulder condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS.  In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended left shoulder condition, the panel agrees it cannot recommend it for additional disability rating.  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.