RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05297
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070910

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4 , Calvary Scout, medically separated for “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 - 20070725	VARD - 20080310	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5099-5003	0%	Status Post-Surgical Repair Left Knee 	5260	0%	20071115	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent arthroscopic left knee surgery in November 2006 to repair a large lateral condyle defect and in April 2007 underwent surgery to remove a large osteochondral fragment with medial meniscal debridement.  The surgeries coupled with physical therapy (PT) and profiles were deemed unsuccessful.  The 27 June 2007 MEB NARSUM examination, 3 months prior to separation (2 months after surgery), noted complaints of left knee pain.  There was no pain when supine or in a non-weight-bearing position, but with average activity, his daily pain was 3-4/10 in intensity.  At least twice per week, his pain increased to a maximum of 5/10 intensity.  Physical examination showed left knee range of motion (ROM) with flexion of 120 degrees (140 normal) and extension of minus 15 degrees (0 normal), limited by pain.  The physical therapy (PT) examination on 17 July 2007 documented a normal gait with ROM showing flexion of 130 degrees and extension of 0 degrees (painful motion was not addressed).  

At the 15 November 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported intermittent knee pain.  X-rays revealed focal osteochondral defect involving the lateral femoral condyle.  Physical examination showed a normal gait.  The left knee had slight swelling (41 cm compared to 39 and 40 cm of the opposite side) with no signs of inflammation, erythema or tenderness.  Left knee ROM showed flexion of 135 degrees and extension of 0 degrees, with no pain.  There was no ligament instability noted.  On repeat testing, there was no limitation of motion, but “on extending the knee after flexion there was popping felt, but there was no other crepitus noted.”  There was no additional loss of ROM due to painful motion, weakness, paired endurance, incoordination, instability or acute flares.  The CI was able to heel and toe walk and squatting was normal, but he did have popping and slight discomfort when standing from squatting.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing degenerative arthritis with loss of joint motion due to pain alone, and not mechanical block (with likely application of AR 635-40, B-29 in effect at the time).  The VA also rated the left knee condition 0%, coded 5260 (leg, limitation of flexion), based on the C&P examination, citing a noncompensable evaluation whenever leg flexion is limited to 60 degrees.  

The NARSUM examination documented extension limited to 15 degrees, which potentially supported a 20% rating under code 5261 (leg, limitation of extension); however, that examination was only 2 months after surgery and a subsequent pre-separation PT evaluation and the post-separation C&P examination both documented normal extension.  The panel adjudged that the NARSUM examinations’ ROM limitation was an outlier and not sufficient for a 20% rating at separation.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion (5260).  However, the NARSUM and preponderance of evidence documented 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).  Since the CI had meniscal repair during his surgeries, the analogous 5259 code (cartilage, semilunar, removal of, symptomatic) was considered applicable in this case but the maximum 10% rating under that code provided no benefit to the CI.  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 recommends a disability rating of 10% for the left knee condition, 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%	

, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed 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 permanent retirement with disability.  I have reviewed the Board’s recommendation and 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 Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.