RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX 	CASE:  PD-2017-05042
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080726

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Network System Operator/Maintainer, medically separated for “right knee pain” with a disability rating of 10%.   

CI CONTENTION:  “The pain in my knees make it difficult to squat, pick up things, and even carry my children.”  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 - 20080409	VARD - 20090805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5003	10%	Degenerative Arthritis of the Right Knee	5003-5260	10%	20090511	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee pain began in November 2005 after sprinting, but he did not recall any pain or “pop,” and subsequently experienced daily aches and stiffness.  Physical therapy followed without improvement, and in the fall of 2006, he had right knee locking and pain with sitting, standing up, and running.  During a fitness test run in February 2007, the right knee gave way and the CI collapsed.  An MRI on 23 April 2007 showed degenerative changes to the posterior horn of the medial meniscus, with intact ligaments and no effusion, chondromalacia, or osteochondral defects; patellofemoral pain syndrome was diagnosed.  The 2 May 2007 orthopedic examination showed tenderness of the inferior pole of the right patella without defect and a firm area in the tendon.  There was no effusion, joint line tenderness, or instability.  On 28 December 2007, physical therapy performed a range of motion (ROM) evaluation which showed flexion of 123 degrees (normal 140) and extension of 0 (normal), with painful motion.  Lachman’s testing was negative and knee X-rays on 17 January 2008 were normal.

During the 17 January 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, physical examination revealed pain with ROM and knee X-rays were negative.  The 23 January 2008 MEB NARSUM examination, noted complaints of anterolateral right knee pain described as sharp and constant, with stiffness and intermittent throbbing.  Pain was exacerbated by kneeling, lifting, carrying objects, running, going up/down stairs, sitting and bending the knee; surgery was not indicated.  Physical examination showed tenderness, and pain with flexion and extension as well as with patellar grind and deep palpation at the patellar tendon.  There was no evidence of instability.  

At the 12 May 2009 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported sharp pain below the knee cap with symptoms unchanged over the previous few years.  He used a knee brace depending on the activity.  Physical examination (with CI sitting at the edge of the table) showed flexion to 90 degrees, with a loud palpable clicking, and full extension.  There was “a great deal of discomfort” with palpation of the patella and medial joint line.  A right knee MRI showed early degenerative joint disease and a congenital variant of the patellofemoral joint (lateral patella and a narrow patellofemoral groove) that became symptomatic on active duty.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5003 (arthritis, degenerative), citing painful motion of one joint.  The VA also rated the right knee condition 10%, coded 5003-5260 (degenerative arthritis-leg limitation of flexion), based on the C&P examination. Members noted 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) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of recurrent subluxation, ligamentous instability or laxity (5257), history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or 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 than the 10% rating adjudicated by the PEB supported under any applicable VASRD §4.71a 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 right knee pain condition.  

BOARD FINDINGS:  In the matter of the right 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.

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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.

Sincerely,					      
Enclosure