RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04455
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Wheeled Vehicle Mechanic, medically separated for “bilateral knee pain,” rated 10% each knee, with a combined disability rating of 20%.  

CI CONTENTION:  He believes his knees should have been rated a minimum of 80% and he has applied for disability for conditions not evaluated by the Medical Evaluation Board (MEB) or the 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 - 20090421	VARD - 20100623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Knee Pain	5099-5003	10%	Right Knee S/P Meniscectomy	5257	10%	20100601	
		10%	Left Knee Meniscectomy	5260	0%	20100601	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery for a meniscal tear in 2000 and was subsequently medically separated.  However, in October 2007 he reenlisted with a waiver.  He injured his left knee in November 2007 after twisting his knee and underwent left knee arthroscopy in April 2008 for medial meniscus debridement.  His right knee began hurting again after reentering the Army but without additional injury.  He underwent right knee partial medial meniscectomy and chondroplasty of the patella in August 2008.  He continued to have bilateral knee pain and there was no additional surgical indication.  

During the 12 December 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI complained of “arthritis in both knees.”  Physical examination revealed decreased range of motion (ROM) with tenderness, effusion and crepitus in both knees.  

At the 26 February 2009 MEB NARSUM examination, 4 months prior to separation, the CI complained of bilateral knee pain “80% of the time” with give-way and catching, but no locking.  He was unable to run, walk further than a quarter mile or stand greater than 30 minutes.  It was painful to do push-ups, sit-ups or carry greater than 45 pounds.  Physical examination showed a normal gait at the beginning of the examination, but later it became mildly antalgic.  There was trace effusion in each knee.  Active ROM testing showed 0-120 degrees (normal 0-140) of right knee motion (extension to flexion) and 0-110 degrees of left knee motion.  There was pain-limiting motion, bilaterally, and increased pain with repetitive motion.  

The 1 June 2010 VA Compensation and Pension (C&P) examination, 11 months after separation, noted no incapacitating episodes of arthritis.  The CI could stand for 15-30 minutes and walk up to a mile.  On examination, his gait was normal.  Right knee ROM was 125 degrees of flexion (normal 140) and 0 degrees of extension (normal).  Left knee flexion was 130 degrees and extension was 0 degrees.  There was no pain with motion or additional limitation with repetitive use in either knee.  Left knee X-rays showed minimal degenerative changes.  Right knee X-rays were not discussed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right and left knee conditions 10% each, analogously coded 5099-5003 (degenerative arthritis), citing satisfactory evidence of painful motion.  The VA rated the right knee condition 10%, coded 5257 (knee impairment with recurrent subluxation or lateral instability), based on the C&P examination, citing slight recurrent subluxation or lateral instability.  The VA rated the left knee condition 0%, coded 5260 (limitation of flexion), based on the C&P examination, citing non-compensable ROM without painful motion.  

There was no limitation of motion, which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) for either knee.  However, there was evidence of painful motion with functional loss supporting a 10% rating for each knee (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.  The 5259 code (cartilage, semilunar, removal of, symptomatic) was applicable in this case for both knees but the maximum 10% rating under that code provided no rating advantage to the CI.  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) for either knee.  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB for either knee under any applicable code.  After due deliberation, considering all of 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 and left knee conditions.  

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 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:

AR20180016690, XXXXXXXXXXXXXXXXXX

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.