RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX 	CASE:  PD-2017-04158
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080131

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Cannon Crewmember, medically separated for “injury to right knee” with a disability rating of 0%.   

CI CONTENTION:  In addition to the right knee, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080410	VARD - 20080703	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Injury	5099-5003	0%	Right Knee	5257	10%	20080422	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Knee Injury.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee lateral meniscus debridement and patellar chondroplasty.  Despite physical therapy, the CI reported continued pain and swelling.  Range of motion (ROM) measurements for the MEB were completed by physical therapy on 27 September.  The right knee ROM following repetitive movement was flexion of 130 degrees (normal 140), limited by pain, and extension of 0 degrees (normal).  The 17 October 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain and swelling along the medial aspect of the right knee.  Physical examination showed tenderness along the medial and lateral joint lines, but no effusion and excellent quadriceps tone.  There was pain with McMurray’s maneuver (meniscal pathology). 

At the 22 April 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported right knee pain and stiffness.  Physical examination showed a normal gait.  The ROM study showed flexion of 114 degrees, which was reduced to 100 degrees after repetition due to pain.  Extension was 0 degrees.  X-rays of the right knee were normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing arthritis of one major joint without ratable limitation of motion.  The VA rated the right knee condition 10%, coded 5257 (knee, other impairment of), based on the C&P examination, citing painful motion.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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).  However, a 10% rating under code 5259 (cartilage, semilunar, removal of, symptomatic) was applicable in this case and supported a 10% rating.  The panel also agreed there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45), but this provided no rating advantage to the CI.  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 right knee condition, coded 5259.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5259 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	
Right Knee 	5259	10%	

The following documentary evidence was considered:

AR20190004292, XXXXXXXXXX

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Dear XXXXXXXXXX:

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.