RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05069
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Patriot Missile Operator/Maintainer, medically separated for “right knee pain” 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 - 20081208	VARD - 20090129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	S/P Complex Tear of the Meniscus, Right knee	5257	10%	20090105	
			Osteoarthritis and Patellofemoral Syndrome with Stress Fracture, Right Knee	5010-5260	10%	20090105	
Depression 	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right knee surgery in August 2007 to repair a lateral meniscal tear.  He initially improved, but after a few months right knee pain returned, especially with running.  An MRI in May 2008 showed possible partial tear or strain of the patellar tendon, medial and lateral meniscal tears and a Baker’s cyst.  A June 2008 bone scan showed a possible stress fracture.  Physical examination showed a normal gait and testing for meniscal pathology was positive.  He was diagnosed with meniscal tear and closed stress fracture of the tibia, but the orthopedist thought surgery was not an ideal option.  During the 18 September 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported right knee pain.  Physical examination showed tenderness.  At the physical therapy MEB ROM study on 18 September 2008, after repetition showed flexion of 112 degrees (normal 140) and extension of 1 degree (normal 0) with painful motion.  The knee was stable and without swelling, muscle atrophy, deformity or scarring.  During a 19 September 2008 MEB termination examination, the CI reported right knee pain aggravated by weight bearing activities.  Physical examination showed swelling and tenderness, but the CI had a normal gait and stance. 

The 29 October 2008 MEB NARSUM examination, 2 months prior to separation, noted the CI was only able to walk a half mile, couldn’t do squats and used a cane in the right hand.  He reported locking of his right knee, but did not describe true locking.  Physical examination showed tenderness below the patella.  There was minimal tenderness of the joint lines and no evidence of instability.  Right knee ROM testing showed pain limited flexion of 90 degrees and extension of 0 degrees.  The examiner indicated the CI had the beginnings of arthritis in the right knee.  

At the 5 January 2009 VA Compensation and Pension (C&P) examination, 2 days before separation, the CI reported right knee pain.  The CI walked with the aid of a cane and had a slight limp, but the examiner indicated the CI could walk adequately and his “physical limitation was “minimal” that day.  On examination, there was mild evidence of laxity on testing.  Testing for meniscal pathology was negative.  Right knee ROM after repetitive motion showed flexion of 140 degrees and extension of -8 degrees, with evidence of painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5003 (arthritis, degenerative), citing tenderness and painful ROM with slight loss of flexion (115 degrees) when compared to left knee (125 degrees).  The VA rated the right knee condition 10%, analogously coded 5260 (leg, limitation of flexion of) and 10% coded 5257 (knee, other impairment of), based on the VA C&P examination, citing slight instability of the right knee.  

There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (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).  The 5259 code (cartilage, semilunar, removal of, symptomatic) was also applicable in this case and supported an alternate 10% rating.  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.  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).  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 condition.  

Contended PEB Conditions:  Depression.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The depression was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.  

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 contended depression, the panel recommends no change from the PEB determination as not unfitting.  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.  

AR20190007044, 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.