RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-04351
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050606

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was active duty E4, Infantryman, medically separated for “left knee osteoarthritis” with a disability rating of 10%.

CI CONTENTION:  The condition continues to worsen.  The complete submission is 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 - 20050405	VARD - 20050728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Osteoarthritis	5003	10%	Left Knee Osteoarthritis	5010	10%	20050301	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Left Knee Osteoarthritis. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition began in October 2002, while playing flag football; he heard a loud pop in his left knee and had immediate pain and swelling. Emergency room X-rays showed no fractures or dislocations. The CI subsequently had an arthroscopic procedure done  in October 2003. He was told that no meniscal tear was found and that he had severe degeneration of the medial meniscus due to overuse and the presence of osteoarthritis.

The 24 January 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of severe pain and swelling which prevented any physical training. Physical examination showed effusion of the knee joint with tenderness. There was medial and lateral ligament looseness. Range of motion (ROM) was reduced with flexion of 90 degrees (normal 140) and extension to 170 degrees. An MRI done 2 days later showed an “abnormal cystic lesion anterior medial aspect of the proximal tibia and cystic lesions adjacent to the popliteal artery and vein.”

At the 1 March 2005 VA Compensation and Pension (C&P) examination, 3 months prior to separation the CI reported constant pain. Physical examination showed drawer and McMurray's tests were within normal limits. The ROM of the left knee joint was flexion to 140 degrees, and extension 0 degrees (normal). The ROM was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10%, coded 5003 (degenerative arthritis). The VA also rated the left knee condition 10%, coded 5010 (traumatic arthritis) based on the C&P examination, citing painful or limited motion of the left knee.

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 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.

The following documentary evidence was considered:

	PD-2017-04351

AR20190012185, XXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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.