RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03539
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20090713

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Gaurd E2, Trainee, medically separated for “right knee pain” with a disability rating of 10%.  

CI CONTENTION:  The condition continues to worsen and will require a knee replacement.  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 - 20090629	VARD - 20091109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Chronic Right Knee Strain 	5260	10%	20091016	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent patellar tendon debridement on 5 February 2009 for Osgood-Schlitter disease.  Postoperatively he complained of increased pain in his right knee with episodes of instability, usually 15-20 a day, reporting that his knee buckled backwards and to the right, but denied locking.
  
The 7 May 2009 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic right knee pain.  Physical examination showed an antalgic gait favoring his right lower extremity with 2+ edema noted.  The tendon and incision were extremely tender with tenderness over an obvious bony prominence at the tibial tuberosity.  There was no erythema, patellar tilt laxity or grinding, but there was significant atrophy at 5.5 cm from the proximal patellar pole measured at 46.5 cm on the right compared to 48 cm on the left.  Active range of motion (ROM), measured by goniometer, demonstrated flexion of 140 degrees (normal) and extension of 0 degrees (normal).    

At the 16 October 2009 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported worsening right knee pain with stiffness, instability, locking, weakness, swelling, giving way and fatigability.  The CI also reported painful flare-ups, which were moderate to severe with prolonged driving, standing, kneeling or sitting.  Physical examination showed the CI was using a cane to ambulate and had an antalgic gait (limp).  Painful ROM was measured with flexion of 130 degrees and extension of 0 degrees after repetition.  Tenderness and fatigue were also noted during ROM testing.  X-rays of the right knee showed no evidence of acute abnormalities but there was mild effusion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing painful motion of major joint.  The VA also rated the right knee condition 10%, coded 5260, (leg, limitation of flexion of), citing painful motion.  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 no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under that code.  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 higher rating than the 10% adjudicated by the PEB under any applicable VASRD code.  After due deliberation, considering all of 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 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 

AR20180009200, 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