RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxx 	CASE:  PD-2017-05088
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080507

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Combat Engineer, medically separated for “malunion of an old tibial plateau fracture, with right knee degenerative arthritis,” with a disability rating of 20%.  

CI CONTENTION:  No specific contention was made.  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 - 20080306	VARD - 20090130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Malunion of an Old Tibial Plateau Fracture, with Right Knee Degenerative Arthritis	5262	20%	Residuals, Status Post Right Tibial Plateau Fracture with Early to Moderate Degenerative Joint Disease	5262	10%	20080724	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Malunion of an Old Tibial Plateau Fracture, with Right Knee Degenerative Arthritis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began in 2004 after falling and landing on the kneecap while on patrol.  The condition was aggravated while running in July 2007.  An MRI of the right knee showed degenerative changes and osteochondritis dissecans.  The 12 December 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of right knee pain.  Physical examination showed prepatellar pain and pain along both lateral joint lines.  Lachman’s test was negative.  Right knee ROM testing showed flexion of 105 degrees (normal 140) and extension of 0 degrees (normal) with crepitus and pain with pressure in the joint.  

At the 24 July 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported flare-ups occurring approximately twice a week due to twisting of the right knee, which lasted a few hours.  Physical examination showed a normal gait and appearance with no obvious deformity or osteophytosis.  There was no local warmth, but there appeared to be slight joint effusion on compression of the suprapatellar area.  Right knee repetitive ROM testing showed flexion of 130 degrees and normal extension, with no pain with motion noted.  Provocative testing revealed no ligamentous laxity or meniscal pathology.  However, there was some patellar crepitus, joint line tenderness over the medal compartment and slight tenderness over part of the tibia, mostly medially.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 20%, coded 5262 (tibia and fibula, impairment of), citing displacement of the lateral shaft of the tibia, including the articular surfaces consistent with moderate knee disability.  The VA rated the right knee condition 10%, coded 5262, based on the C&P examination, citing malunion of the tibia and fibula with slight knee or ankle disability.  There was no evidence of marked knee disability to support a 30% rating under the 5262 code.  There was no limitation of motion (5260, 5261), and no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under that 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 condition.   

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.  

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Dear XXXXXXXXXXXXXX:

	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.