RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04560
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20060701

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Food Service Specialist, medically separated for “right knee pain” with a disability rating of 0%.  

CI CONTENTION:  “Rating is for bilateral knee pain which continues to get worse.  I have had surgery twice on my knee since separation.  My knee also swells a lot and the pain causes a limp.  I also get sharp pain in my knee when attempting to stand normal with legs locked.  I am unable to extend my leg in order to stand completely straight with pressure on my left knee.  I have also been rated for migraines which have also got worse and occur weekly.  The migraines last at least 4 days once they occur.  I also have continued pain in my left shoulder with this pain it prevents full range of motion to include extending or bending my arm to any degree.”  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 - 20060522	VARD - 20070731	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5009-5003	0%	Retropatellar Pain Syndrome, Right Knee	5261	10%	20061010	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in May 2005 after falling during basic training.  X-rays and MRI were normal.  Orthopedics stated her problems could not be helped by surgery.  

During the primary care clinic visit on 20 March 2006, the CI complained of nagging right knee pain which increased with cold weather.  Physical examination showed strength of 4/5 with extension and flexion.  Gait was normal and there was tenderness to palpitation at the medial and lateral patella facet.  Right knee range of motion (ROM) was flexion of 130 degrees (normal 140) and extension of 0 degrees (normal).  Painful ROM was not annotated.  

The 30 March 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of "constant knee pain in both knees, especially the right one that keeps me from running or walking any distance."  Physical examination showed a normal gait.  Muscle tone and strength were normal and there was no edema.  She was able to squat without difficulty, but "duck walking" across the floor caused discomfort, but she was able to complete the duck walk.  Right knee ROM performed with a goniometer was flexion of 140 degrees and extension of 0 degrees after repetition.  Painful motion during ROM was not annotated.  

At the 10 October 2006 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI complained of right knee pain rated 4/10 associated with walking for 1 hour.  She reported the knee would give way going up and down stairs.  She was not working and was 3 months pregnant.  Physical examination showed a normal gait and upright posture.  There was no effusion and ROM after repetition showed flexion of 117 degrees and extension of 0 degrees with pain on movement of the patella.     

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 degenerative arthritis with full ROM.  The VA rated the right knee condition 10%, coded 5261, (leg, limitation of extension of), based on the C&P examination, citing limited range of motion and painful motion.  There was no objective evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  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).  No additional functional limitation was evidenced by the examinations.  Therefore, the panel concluded there was insufficient evidence to support a rating higher than the 0% adjudicated by the PEB.  

BOARD FINDINGS:  In the matter of the right 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:

Exhibit A.  DD Form 294, dated 20170426, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180006667, XXXXXXXXXXXXXXXXXX

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.

Sincerely,					      
Enclosure