RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04200
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Military Policeman, medically separated for “chronic right knee pain” with a disability rating of 10%.  

CI CONTENTION:  In addition to the right knee condition and anxiety disorder, the CI also requested review of an additional condition 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 - 20081202	VARD - 20090417	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Residuals, Meniscal Tear, Right Knee	5024	10%	20090122	
Anxiety Disorder	Not Unfitting	Posttraumatic Stress Disorder	9411	50%	20090205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery in April 2007 for anterior cruciate ligament reconstruction.  Postoperative MRI from October 2008 showed the screw and ACL graft to be intact along with degenerative changes.  There was increased signal in the meniscus, which most likely was consistent with postoperative changes, but a small repeat undersurface flap tear was not excluded.  

During the 2 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the CI reported chronic right knee pain.  Physical examination revealed an abnormal gait with tenderness on the medial aspect of the right knee, but there was no edema or effusion.  Motor strength and deep tendon reflexes were normal.  Pain was elicited by flexion, but no range of motion (ROM) measurements were provided.  

The 20 October 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic 3/10 right knee pain with flare-ups at 7/10.  Physical examination showed the CI walked with a slight limp.  Gross appearance of the knee was normal, except the presence of a small vertical well healed surgical scar.  There was no tenderness, no effusion and the drawer test was negative.  He had a minimal anterior translocation of the tibial plateau and there was a “rock-solid” stable endpoint.  Sensation, strength, deep tendon reflexes and heel-to-toe walking were normal.  The ROM study showed flexion of 80 degrees (normal 140), with pain, and normal extension (0 degrees).  

At the 22 January 2009 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported pain, weakness, stiffness, fatigue and lack of endurance of the right knee.  Physical examination showed a normal gait and posture without swelling, effusion or ligament instability.  However, there was tenderness over the medial joint line and popliteal area.  Neurological examination was intact.  Right knee ROM testing showed flexion of 130 degrees, with pain, and extension of 0 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5003 (arthritis, degenerative), citing limitation of motion of one major joint.  The VA also rated the right knee condition 10%, coded 5024 (tenosynovitis), based on the VA C&P examination, citing painful motion noted on flexion.  
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), or history of surgery to remove a meniscus (5259) to support a rating under those codes.  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 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 right knee condition.  

Contended PEB Condition:  Anxiety Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder, the panel recommends no change from the PEB determination as not unfitting.  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.  
The following documentary evidence was considered:  

AR20190004436, XXXXXXXXXX

Dear XXXXXXXXXX:

	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.