[AR Number], XXXXXXXXXX. 

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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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX.	CASE:  PD-2017-04608
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “chronic pain, left knee” 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 - 20050324	VARD - 20050614	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Left Knee	5099-5003	10%	Chondromalacia, Left Knee	5014	10%	20050315	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee pain began in January 2003 after running up and down stairs without any specific injury or trauma.  A left knee MRI showed a partial tear of the lateral collateral ligament, bone contusion involving the lateral femoral condyle, and a very small joint effusion.  Subsequent MRI studies showed a lateral meniscal tear, irregularity of the subchondral bone of the lateral femoral condyle and a possible articular cartilage abnormality.  Orthopedic evaluation indicated the CI was not a surgical candidate.

The 31 January 2005 orthopedic examination, 3 months prior to separation, noted complaints of “intermittent knee locking” aggravated by extended activity, kneeling and navigating stairs.  The provider documented left knee tenderness, but no crepitus, erythema or swelling.  Genu valgum (knock knee) was noted along with increased medial and lateral patellar mobility.  There was also knee laxity and a positive anterior (but no posterior) drawer sign.  Provocative testing for meniscal pathology was negative and there was full range of motion (ROM) without pain.  

During the 24 February 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months before separation, the CI reported left knee swelling when walking or running, and that the knee frequently gave out, even when she wore a brace.  Physical examination revealed genu valgum, tenderness, and discomfort (pain) with ROM testing, but no effusion or instability.  The MEB NARSUM examination, on the same day, noted complaints of significant difficulty climbing stairs and prolonged standing.  The examiner documented a slightly antalgic gait, tenderness and mild genu valgum deformity, but no edema, effusion or instability.  Provocative testing for meniscal pathology was negative.  The goniometric ROM evaluation showed flexion of 140 degrees (normal) and extension of 0 degrees (normal) with discomfort (pain).  

At the 15 March 2005 VA Compensation and Pension (C&P) examination, approximately 2 months prior to separation, the CI reported constant left knee pain and swelling, but denied incapacitation.  Physical examination showed a normal gait with left knee crepitus, but no findings of ankylosis, recurrent subluxation, locking pain or joint effusion.  Provocative testing for meniscal pathology was negative.  Left knee ROM showed flexion of 120 degrees and extension of 0 degrees.  There was no additional limitation based on pain, fatigue, weakness, lack of endurance or incoordination after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5003 (degenerative arthritis), citing slight and frequent pain IAW the US Army Physical Disability Agency pain policy.  The VA also rated the left knee condition 10%, coded 5014 (osteomalacia), based on the C&P examination, citing limited motion of a major joint.  Members noted that there was no limitation of flexion or extension which supported a rating under diagnostic codes 5260 or 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).  Additionally, 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 chronic left knee pain 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: