RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03571
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050613

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Medical Supply Specialist, medically separated for “chronic pain, left knee,” with a disability rating of 0%.  

CI CONTENTION:  Review all conditions.  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 - 20050413	VARD - 20050727	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	0%	Chondromalacia of Lateral Femoral Condyle, Left Knee	5299-5259	10%	20050412	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Pain, Left Knee.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent left knee surgery in January 2004 for anterior cruciate ligament (ACL) reconstruction, micro fracture repair and partial lateral meniscectomy.  She underwent revision ACL reconstruction, medial meniscal tear debridement and lateral femoral condyle osteochondral allograft in November 2004.  She noted improvement with swelling and instability but continued to have pain in the knee that prevented her from returning to full duty.  

During the 21 March 2005 MEB NARSUM examination, 3 months prior to separation, the CI complained of 2/10 left knee pain that worsened to 8/10 with prolonged walking and increased activity.  Physical examination showed full range of motion (ROM) with trace effusion, mild patellofemoral crepitus and negative grind test.  The examiner reported anterolateral joint line tenderness that was increased at 90 degrees of flexion.  Tests for instability were negative.  

At the 12 April 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported constant left knee pain.  The CI was employed in the same job for the past 5 years and was able to perform activities of daily living, including climbing stairs, gardening and taking out the trash.  Physical examination showed a normal gait.  Left knee ROM was reported as full and not additionally limited by pain, fatigue, weakness and lack of endurance or incoordination after repetitive use.  General appearance of the left knee showed three level vertical scars without pain, tissue loss or loss of pigmentation.  Tests for instability or meniscal pathology were negative.  X-rays of the left knee showed the joint within normal limits and evidence of post-surgical screws.  The examiner noted no functional impairment affecting occupation or daily activity.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing minimal and constant pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the left knee condition 10%, analogously coded 5299-5259 (cartilage, semilunar, removal of, symptomatic) based on the C&P examination, citing chondromalacia of the lateral femoral condyle following multiple meniscal surgeries that resulted in painful knee motion.  

There was pain with any significant impact or weight bearing motion of the knee.  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) to support a rating under that code.  There was no fracture, nonunion, or mal-union 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 with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case, and provided an alternate route to a 10% rating.  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 left knee condition, coded 5259.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5259 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, Left Knee	5259	10%	

AR20180015386, 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.