RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05023
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050520

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

CI CONTENTION:  In addition to the right knee condition, the CI requested review of her mental health disorder.  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 conditions 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 – 20050406	VARD – 20050608 and 20060523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee	5099-5003	0%	Degenerative Joint Disease, Right Knee	5010-5260	10%	STR	
Anxiety Disorder	Not Unfitting	Post-Traumatic Stress Disorder	9411	10%	20051220	
Depression	Not Unfitting					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

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 2003 during initial entry training.  The CI was issued a profile but continued to have occasional aches and pains.  In January 2004, the CI was involved in a motor vehicle accident and her right knee was impacted.  X-rays showed patellofemoral joint arthritis but MRI showed bone contusions of the distal femur, medial femoral condyle and medial aspect of the patella, with a suprapatellar effusion, consistent with a patellar dislocation.  Orthopedics indicated there was no surgical option and recommended an MEB for patellar tendonitis and patellar chondromalacia.  The 11 January 2005 MEB NARSUM examination, 4 months prior to separation, showed a calcified hematoma of the inner right thigh.  The physical therapy (PT) range of motion (ROM) study on the same day showed active right knee flexion of 115 degrees (normal 140) and extension of 0 degrees (normal) with pain during passive ROM testing.

At an orthopedic visit on 7 February 2005, 3 months prior to separation, the CI reported constant knee pain aggravated by squatting, kneeling and stairs, without locking or giving way.  Physical examination showed no effusion and a stable right knee without evidence of meniscal pathology.  The ROM study showed right knee flexion of 130 degrees and extension of 0 degrees.  The patellar grind test was positive.  Right knee X-rays showed patellar arthritis, but the examiner did not recommend surgery.  A primary care on 15 June 2005, 1 month after separation, noted patellar crepitus with ROM testing and a normal gait.  A replacement neoprene hinged brace for the patella was ordered.  

During a VA orthopedic examination on 9 December 2005, 7 months after separation, the CI reported wearing out a knee brace that had been worn for 12 months.  Physical examination showed tenderness of the patellar tendon and medial joint line.  The patella was laterally subluxed out of the socket.  

A VA physical medicine examination on 19 December 2005 noted the CI was recently given a patellar stabilizing brace.  She reported her right knee gave way and she was unable to do squats or get up from a bent-knee position.  Physical examination showed limited flexion with painful extension and patellar crepitus.  MRI on 28 December 2005 showed mild bruising of the quadriceps tendon but was otherwise normal.  

At an orthopedic examination on 9 February 2006, 8 months after separation, the CI reported constant pain with knee flexion, giving way and inability to perform squats, but denied locking.  Physical examination showed patellar pain with compression and translation of the patella.  There was full ROM and testing for meniscal injury caused pain, but not in the area of the meniscus.  A diagnostic arthroscopy was performed on 6 March 2006, 9 months after separation, with lateral patellar release and plicectomy.  The post-operative diagnosis was patellofemoral disease, with operative findings of lateral patellar subluxation without chondromalacia.  

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), with application of the US Army Physical Disability Agency pain policy.  The VA rated the right knee condition 10%, dual coded 5010-5260 (traumatic arthritis causing limitation of leg flexion), based on the STR, citing painful motion.  

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 imaging evidence of arthritis and painful limited motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The CI’s initial traumatic injury involved dislocation of the patella; however, the panel majority noted prior to separation and/or proximate to separation there was no evidence of recurrent patellar subluxation or lateral instability (5257) to support a rating under that code.  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under that code.  There was no fracture, non-union, 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 higher rating supported than 10% under any applicable VASRD code.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the right knee condition, coded 5099-5003.  

Contended PEB Conditions:  Anxiety Disorder and Depression.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions was profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right knee condition, the panel majority recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a. The single voter for dissent recommends modification to 20% but does not elect to submit a minority opinion.  In the matter of the contended anxiety and depression conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Pain, Right Knee	5009-5003	10%	

XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has been provided to the counsel you listed on your application; XXXXXXXXXXXX, XXXXXXXXXXX.

Sincerely,					      
Enclosure