RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-03886
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060321

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic left knee pain” with a disability rating of 10%.  

CI CONTENTION:  “Condition of injury has deteriorated greatly since, causing more issues.”  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 - 20060308	VARD - 20060707	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	10%	Traumatic Arthritis of the Left Knee	5260	10%	20060627	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent left knee surgery on 5 January 2006, 3 months prior to separation, for an anterior cruciate ligament reconstruction.  The 8 February 2006 MEB NARSUM examination, a month after surgery and a month prior to separation, noted complaints of left knee pain.  Physical examination showed no redness, swelling, heat, effusion, or tenderness.  Left knee flexion was 30 degrees (normal 140) and extension was 0 degrees (normal).  During the 14 February 2006 MEB examination (recorded on DD Forms 2807-1 and 2808) the CI reported knee pain after surgery.  Physical examination showed a “limpy” gait with left knee tenderness, weakness, and swelling. The examiner noted an inability to fully flex the knee.  

At the 29 June 2006 VA Compensation and Pension (C&P) examination, 3 months after separation and 6 months after surgery, the CI reported occasional popping of his left knee accompanied by brief episodes of pain.  Physical examination showed a small suprapatellar effusion, and left knee flexion was 110 degrees with extension of 0 degrees with painful motion.

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 (degenerative arthritis), citing loss of motion and pain.  The VA rated the left knee condition 10%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing X-ray evidence of arthritis with evidence of painful or limited motion.  

The panel noted the MEB NARSUM showed left knee flexion at 30 degrees one month after surgery, and the VA examination showed flexion to 110 degrees at 6 months after surgery.  The panel placed higher probative value on the VA examination since it was conducted further from the left surgery allowing more left knee healing time.  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 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 no evidence of subluxation or lateral instability to support a rating under the 5257 code (knee, other impairment).  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable 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 §4.71a, 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.  

PD-2017-03886

AR20190011733, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXX

	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.

PD-2017-03886