RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05141
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060303

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “chronic left knee pain” with a disability rating of 0%.   

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 - 20060206	VARD - 20060815	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Left Knee Meniscal Tear 	5260	10%	20060520	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Left Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent a diagnostic arthroscopy in November 2004 with debridement of a loose body and osteochondral defect.  The lateral meniscus, lateral femoral condyle and lateral cartilage were intact.  A post-surgical MRI in March 2005 showed an osteochondral lesion in the lateral aspect of the medial femoral condyle.  The CI was diagnosed with degenerative joint disease and osteochondral defect of the left knee.  During the 4 November 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported left knee pain, swelling, locking and giving out.  Physical examination revealed tenderness over the medial femoral condyle without joint line tenderness or effusion.  Stability tests were normal and there was full range of motion (ROM). 

The 7 December 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of 4-10/10 left knee pain varying from a constant dull ache to a sharp stabbing pain.  Physical examination showed mild tenderness and slight effusion about the prepatellar area.  There was diffuse tenderness over the medial aspect of the knee and over the lateral joint line.  All tests for stability were normal.  The knee was neurovascularly normal.  The left knee ROM evaluation showed flexion of 130 degrees (140 normal) and extension of 0 degrees (normal). Strength was 5/5 in extension and flexion.  The orthopedic examiner noted that the CI walked with a cane and had a slight limp in his left leg.  

At the 20 May 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant burning, aching and occasionally sharp 7/10 left knee pain.  The examiner recorded left knee effusion, weakness, tenderness, warmth and guarding of movement.  Examination of the left knee revealed 'locking' pain, joint effusion and crepitus.  Left knee ROM testing showed flexion of 110 degrees and extension of 0 degrees.  All tests for stability were normal.  Provocative testing to elicit meniscal pathology was positive.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic left knee condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing degenerative arthritis without loss of joint motion.  The VA rated the left knee condition 10% coded 5260 (leg, limitation of flexion), based on the C&P examination, citing limited ROM with pain.  

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).  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 of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition, analogously coded 5099-5003.  

BOARD FINDINGS:  In the matter of the left knee condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  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 Left Knee Pain	5099-5003	10%	

AR20180015251, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) review 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 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 Boards records.  I regret that this facts of the case did not provide you with the outcome you may have desired.

	This decision is final.  Recourse with 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 also been provided to the Department of Veterans Affairs.