RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-04352 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20081126

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Light Wheel Vehicle Mechanic, medically separated for “right knee pain” with a disability rating of 10%.

CI CONTENTION:  “Review all 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’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 - 20081118	VARD - 20091106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5299-5262	10%	Right Knee Strain…	5299-5262	10%	20090817	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Chronic Right Knee Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s knee condition began in April 2008 while running. She was seen at the Troop Medical Clinic and was prescribed non-steroidal anti-inflammatories and a topical analgesic heat rub. She was given crutches for comfort, tramadol and a profile for no running. Despite interventions, she continued to have progressively worsening pain and swelling. A bone scan later revealed a stress fracture of the right medial tibial plateau. She underwent physical therapy (PT) and was transferred to the Physical Training and Rehabilitation program. All modalities of treatment proved unsuccessful.

The 17 September 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of right knee pain. Physical examination of the right knee revealed tenderness on ambulation, however, there was no erythema or warmth. There was no patellofemoral lateral tracking and the lateral mobility of the patella was not increased. There was no instability, nor anterior or posterior drawer signs of either knee. There was no posteromedial rotary instability of the knee. The right knee revealed some swelling and tenderness but there was no crepitus on motion noted. The PT evaluation on 24 September 2008 revealed right knee range of motion (ROM) flexion of 140 degrees (normal). Measurements were obtained with a goniometer and repeated three times.

At the 17 August 2009 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported right knee pain as 8/10. Physical examination of the right knee revealed tenderness, but no signs of edema, instability, abnormal movement, effusion, weakness, redness, heat, deformity, guarding of movement, malalignment or drainage, and no subluxation. Right knee ROM was 0 to 140 degrees with pain at 140 degrees. X-ray findings were within normal limits.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the knee condition 10%, analogously coded 5299-5262 (tibia and fibula, impairment). The PEB cited evidence of painful ROM of one major joint, and, IAW VASRD §§4.10, 4.40, 4.45 and 4.59. The VA based the rating on the C&P examination, citing tenderness and pain. 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). 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 knee condition.

BOARD FINDINGS: In the matter of the knee condition and IAW VASRD §4.59, 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-2017-04352
AR20190012713, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX

	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.