RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-03804
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Heavy Wheeled Vehicle Mechanic, medically separated for “chronic left knee pain” with a disability rating of 10%.  

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 20060705	VARD - 20070413	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain 	5009-5003	10%	Left Patellar Tendonitis	5099-5024	10%	20070112	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in May 2003 after feeling a pop in the left knee when he started to run.  Plain films of the left knee in March 2006 were normal, but an MRI in April 2006 showed chondromalacia patella of the lateral facet of the patella along with a small effusion.  The 7 June 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of pain “all the time.”  A stabilizing brace was only worn at the end of the day for pain.  Physical examination showed an antalgic gait without the brace.  Pain was noted with patellofemoral compression.  Anterior lateral joint line and patella tendon were tender.  The left knee was stable.  Range of motion (ROM) testing showed flexion of 115 degrees (normal 140) and extension of 0 degrees (normal).  

At the 12 January 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported 5-6/10 pain, swelling, giving-way and stiffness.  Pain occurred twice a week and lasted an hour.  There were no episodes of dislocations or recurrent subluxation.  Physical examination showed a normal posture and gait with no assistive devices.  There was positive tenderness to the patellar tendon and patella.  There was painless flexion of 140 degrees and painless extension of 0 degrees, but repetition produced pain on extension.  Medial and lateral collateral ligaments had no motion.  X-ray was “essentially normal.”  

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 flexion limited to 115 degrees.  The VA also rated the left knee condition 10%, analogously coded 5099-5024 (tenosynovitis), based on the C&P examination, citing painful or limited motion of a major joint.  

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) as adjudicated by the PEB.  It was agreed that frequent locking due to dislocated semilunar cartilage was not present, and therefore a 20% rating was not justified under the 5258 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 §4.71, 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:

AR20190010727,  

Dear XXXXXXXXXXXX:

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.