RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-04055
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060825

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Unit Supply Specialist, medically separated for “chronic right knee pain” and “chronic left knee pain,” rated 10% and 0%, respectively, with a disability rating of 10%.

CI CONTENTION:	I  was  given  a  higher  rating by  the  VA  for my 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 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 – 20060724	VARD - 20070322	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Right Knee, Torn Meniscus	5257	0%	STR	
Chronic Left Knee Pain	5099-5003	0%	Residuals, Left Knee Arthroscopy	5257	0%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Chronic Right Knee Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered bilateral knee contusions in November 2003 while deployed to Iraq. He had persistent knee pain but was able to complete the deployment. An MRI in October 2005 was interpreted as a meniscal tear (ligaments intact), followed shortly by arthroscopic surgical intervention, 11 months before separation. No meniscal tear was identified intraoperatively, but there was significant (Grade 3) chondromalacia (damaged cartilage). There was documentation in post-operative STR provider entries of the absence of effusion, locking, or instability. There was no indication of significant range of motion (ROM) limitation or of gait disturbance.

The 9 May 2006 MEB NARSUM examination, 3 months prior to separation, documented nonspecific bilateral knee pain (no differentiation of right versus left severity) that prohibited running, jumping, and loadbearing. The physical examination recorded “mild” patellar

tenderness, no note of effusion, no instability, and normal strength. The NARSUM examiner documented right knee flexion to 130 degrees (normal 140) and extension to 0 degrees (normal). The NARSUM also referenced formal goniometric ROM measurements performed the previous day by physical therapy (PT) for the MEB. The PT examiner charted right knee flexion to 120 degrees and extension limited to minus 6 degrees. There was no temporally probative VA examination or other post-separation evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, coded 5299-5003 (analogous to degenerative arthritis), citing “slight loss of motion.” The VA, based on the same STR evidence, rated the right knee 0% under code 5257 (knee, other impairment), citing failure to report for a scheduled examination and no evidence for the minimum10% criterion (slight instability) of the code.

There was no limitation of motion which supported a rating higher than 10% under the diagnostic codes for limitation of flexion or extension (5260, 5261). There was no evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support a rating under code 5258, and no evidence for joint instability to support a rating under code 5257. There were no other criteria in evidence to support a rating higher than 10% under any applicable VASRD §4.71a code. After due deliberation, considering all the evidence and mindful of VASRD
§4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.

Chronic Left Knee Pain. In addition to the November 2003 injury during deployment as above, the CI reinjured his left knee (mechanism unclear) in June 2004. An MRI demonstrated meniscal and medial collateral ligament tears. He underwent arthroscopic surgery in October 2004, 21 months before separation, the details of which were not in evidence. Some post-operative STR provider entries documented grossly normal ROM, although there were some entries that noted flexion ranging from 116 to 120 degrees and extension from minus 8 to minus 10 degrees. A 28 February 2005 orthopedic entry () specified painful motion. There was ample STR documentation of a normal gait, no persistent effusion or locking, and no instability.

The NARSUM documented the same symptoms and functional limitations for the left knee as those above for the right one. The physical findings and ROM measurements were identical for both knees. The contemporary PT measurements for the left knee were flexion to 130 degrees and 0 degrees extension with detailed findings of painful motion in each plane for both knees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 0%, coded 5299-5003, citing the “slight/occasional” criterion of the U. S. Army Physical Disability Agency pain policy. The VA rating, as charted above, was identical to that for the right knee. Although there was no limitation of motion which supported a minimum 10% rating, as for the right knee, the panel agreed that there was satisfactory evidence for painful motion in support of a minimum rating as specified by VASRD §4.59. Additionally, it was more likely than not that the 2004 surgery included a meniscectomy, and the latter would support application of code 5259 (cartilage, semilunar, removal of, symptomatic) that provides for a 10% rating independently of any other criterion. As per the above analysis for the right knee, there were no other criteria in evidence to support a rating higher than 10% under any other code. After due deliberation, considering all the evidence and with deference to reasonable doubt, the panel recommends a 10% rating for the left knee condition under code 5099-5003.

BOARD FINDINGS: In the matter of the chronic right knee pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the left knee condition, the

panel recommends a disability rating of 10%, coded 5099-5003 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	
Surgical Residuals and Chronic Pain, Right Knee	5099-5003	10%	
Surgical Residuals and Chronic Pain, Left Knee	5099-5003	10%	
	COMBINED	20%	

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

AR20200004482,

Dear XXXXXXXXXXX:

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.

Sincerely,

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