RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-04082 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070601

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Indirect Fire Infantryman, medically separated for “left knee osteoarthritis” with a disability rating of 0%.

CI CONTENTION: The knee condition is not better…knee replacement in September 2015. The complete submission is at Exhibit A.

SCOPE OF REVIEW: The panel’s scope of review is defined in Do DI 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 - 20070409	VARD - 20070522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Osteoarthritis	5003	0%	DJD of the Left Knee Status Post Arthroscopic Surgical Intervention	5010	10%	20050907	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Left Knee Osteoarthritis. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left knee condition began while attending technical training and performing wind sprints in January 2004. The CI was diagnosed with a torn ligament, torn cartilage, and arthritis. In August 2004, the CI underwent an arthroscopic surgery which showed grade V chondromalacia patella with micro fractures. Physical therapy followed but the CI was unable to return to full duty. In February 2005, he was diagnosed with arthritis in the left knee. The CI was placed on incapacitation pay and his knee slowly worsened.

At the 7 September 2005 VA Compensation and Pension (C&P) examination, 20 months before separation, the CI reported continued left knee pain with stiffness, instability, and giving way. Locking was reported, but no weakness, swelling, heat, or redness was reported. Physical examination showed 1+ mild effusion, but no redness or warmth. Mild quadriceps atrophy was present. The patella moved freely and tracked well with lateral and medial stability present. Anterior, posterior and Mc Murray’s sign were negative for instability. Crepitus and popping was present with ROM which was 0 to 114 degrees (normal 140). Pain was present at 0 degrees and increased throughout the ROM test and the limiting factor. The 13 September 2006 imaging studies showed changes consistent with osteoarthritis, including calcification in the soft tissue. The 29 September 2006 ultrasound of the left lower extremity showed non-specific prominence of the popliteal vein but no aneurysm.

The 12 November 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of knee pain all the time; the left was from post-operative arthritis. Motrin was taken and helped but did not eliminate the paint. Considerable difficulties were reported when climbing stairs. Pain was rated moderate and constant. The CI was unable to work due to pain. Physical examination showed full extremity range of motion (ROM) and an antalgic gait. The examiner noted the CI had difficulty moving to and from a squatting position.

During the 19 January 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, physical examination showed full ROM with pain and difficulty moving to and from squatting position, otherwise the examination was normal. At the physical therapy examination on 19 March 2007, 3 months prior to separation, flexion of the left knee was 110 degrees and extension was 0 degrees (normal).  Motion was limited by pain.

At the 27 November 2007 VA C&P examination of the joints, 3 months post-separation, the CI reported continued pain treated with narcotic medication as needed. He reported limitations in standing and an inability to walk more than a few yards. He denied deformity, giving way, instability, or stiffness but reported weakness of the knee. Flare-ups occurred weekly. The CI drove to the appointment but reported he could barely walk to get a wheelchair. The CI was not employed and reported mild affect of activities of daily living. Physical examination showed the CI was in a wheel chair after walking from the parking lot and he refused to stand. He cried from pain at 30 degrees of passive ROM. Knee flexion was to 60 degrees and there was additional loss of motion on repetitive use to 30 degrees due to pain. Extension occurred to 0 degrees. No other disability or abnormality was noted. The November 2007 X-rays showed stable appearing degenerative left knee changes with no joint effusion and 1.6 cm soft tissue calcification in the posterior aspect of the knee joint of indeterminate nature.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee osteoarthritis 0%, coded 5003 (degenerative arthritis), citing condition prevents CI from performing his duty. The VA rated the degenerative joint disease (DJD) of the left knee status post arthroscopic surgical intervention 10%, coded 5010 (arthritis, due to trauma), based on the C&P examination, citing painful or limited motion of a major joint.

The panel noted there were few STRs addressing the left knee condition and considered the NARSUM examination was more probative due to its consistency with other ROM findings. There was no explanation for the deteriorated condition described in the C&P examination. 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 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 malunion of the femur or tibia to support consideration under the respective    codes for knee impairment related to long

bone conditions (5255, 5262). 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 5003.

BOARD FINDINGS: In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5003 IAW VASRD §4.71. 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	
Left Knee Osteoarthritis	5003	10%	

PD-2017-04082

AR20190012031, XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX

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. 

PD-2017-04082