RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03995
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-6, medically separated for “chronic pain, left knee,” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20050712	VARD - 20060405	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	10%	Degenerative Joint Disease, Left Knee	5257-5010	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee condition began in August 2004 after bending her knee “too far down.”  Although X-rays were negative, an MRI showed a medial collateral ligament (MCL) tear.  The pain persisted, and in March 2005, a repeat MRI revealed a healing MCL with chondromalacia (softening of the chondral surface) of the kneecap.

The 24 June 2005 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of throbbing left knee pain which limited prolonged standing and walking.  The physical examination (PE) revealed a normal gait and left kneecap tenderness without joint crepitus.  Provocative clinical testing to elicit joint instability or meniscal pathology was negative.  Left knee range of motion was painful and showed flexion to 110 degrees (normal 140) and normal extension (0 degrees).   

At the 8 December 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported left knee pain that was aggravated by maneuvering stairs, running or prolonged standing.  She wore a knee brace but did not require an assistive device for ambulation.  The PE noted a normal gait, however, there was no focal examination of the left knee; X-rays demonstrated early osteoarthritic changes. 

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 slight and constant pain IAW the US Army Physical Disability Agency pain policy.  The VA also rated the left knee condition 10%, but dual coded 5257-5010 (knee injury, other due to traumatic arthritis), based on the STR, citing painful or limited motion of a major joint.  Panel members agreed that there was no compensable limitation of flexion or extension (5260, 5261), however, there was evidence of painful motion with functional loss supporting a maximum 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); history of surgery to remove a meniscus (5259); or 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 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-2017-03995

AR20190011663, XXXXXXXXXXXXXX

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.

PD-2017-03995