RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-05211
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060518

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Motor Transport Operator, medically separated for “chronic right knee pain” with a disability rating of 10%.

CI CONTENTION: “Chronic right knee pain – medial patellofemoral ligament.” 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 - 20060412	VARD - 20060830	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Status Post (S/P) Medial Patellofemoral Ligament Reconstruction Times Two	5099-5024	10%	20060515	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Chronic Right Knee Pain. According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent right knee medial patellofemoral ligament reconstruction surgery in June 2004 for patellar instability. After a subsequent fall, he developed pain and stiffness that required diagnostic arthroscopy in June 2005. Radiographic studies 8 December 2004 revealed two small bony exostoses from the distal femur that possibly represented  remote  trauma  of  the  medial  collateral  ligament.     At  the  orthopedic      clinic

appointment on 16 August 2005, 7 months prior to separation, the CI complained of stiffness and pain rated at 7/10. Physical examination recorded range of motion (ROM) of 120 degrees flexion (normal 140) and 0 degrees extension (normal). There was no effusion, but the examiner noted quadriceps muscle  atrophy.  The  patient  used  a  continuous  passive  motion  machine.  The 30 January 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued constant right knee pain, rated 8-9/10, with the patella frequently feeling like it was slipping or sliding out of its groove and the CI would have to move it back. Physical examination showed ROM of 85 degrees flexion, extension of 10 degrees (both pain limited) and an antalgic gait. There was tenderness of the patella (both medially and laterally) and pain on grinding. Meniscal and ligamentous signs were both negative.

At the 15 May 2006 VA Compensation and Pension (C&P) examination, 3 days before separation, the CI reported constant, sharp knee pain rated 6-8/10, with swelling, giving way and dislocation. He was unable to stand for long periods, had stiffness after sitting, and difficulty flexing and extending the knee. Physical activity, standing, sitting and walking aggravated the condition. Relief came from rest and medication. The condition did not result in any time lost from work. Physical examination showed a normal gait. ROM showed 100 degrees flexion (with pain at 90 degrees) and normal extension.  All stability tests were within normal limits.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic right knee pain 10%, analogously coded 5003 (degenerative arthritis), citing pain-limited motion. The VA rated the S/P medial patellofemoral ligament reconstruction 10%, analogously coded 5024 (tenosynovitis), based on the C&P examination, citing painful or limited motion. The panel adjudged the VA C&P examination as most probative at the time of separation. There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under those codes. There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable 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 chronic 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.

2	PD-2017-05211

AR20190008481, 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.