RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05546
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was active duty E5, SATCOM System Operator/Maintainer, medically separated for “chronic pain, left knee” with a disability rating of 10%.

CI CONTENTION:  A 2-page statement requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 – 20050810	VARD - 20060801	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Chronic Pain 	5099-5003	10%	Left Knee Pain Status Post Plica Syndrome Surgery	5262	10%	20060524	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Left Knee Chronic Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left knee condition insidiously began in 2000 while in infantry training.  He underwent two arthroscopic surgical procedures; in March 2004 and March 2005, which entailed resection of plica (a fold in the synovial tissue within the joint).  Although having an initial improvement of symptoms, his pain eventually returned and persisted.

The 30 June 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of left knee pain aggravated by prolonged sitting and standing.  The physical examination (PE) revealed a normal gait.  The left knee range of motion (ROM) following repetitive movement noted flexion of 130 degrees (normal 140) and normal extension of 0.  Tenderness was present but there was no comment with regards to the presence of painful motion.  

At the 24 May 2006 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported constant localized left knee pain aggravated by physical activity.  His PE revealed left knee tenderness and a normal gait.  Left knee ROM was flexion to 130 degrees and extension was normal.  Joint flexion was additionally limited by 30 degrees after repetitive use, due to pain, fatigue, weakness, and lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing slight pain in accordance with the US Army Physical Disability Agency pain policy.  The VA also rated the left knee condition 10%, coded 5262 (tibia and fibula, impairment), based on the C&P examination, citing malunion of the tibia and fibula with slight knee or ankle disability.  

Panel members first considered and agreed that although the post-separation VA examination noted additional functional loss due to repetitive motion, such findings were not present upon pre-separation examinations.  There was no record of recurrent injury or adverse pathology in explanation of the more marked ROM deficit reflected by the VA measurements.  While ROM limitations may have progressed over time, there was no significant evidence in the record from which to conclude that the severity near separation approached that portrayed by the VA findings.  Therefore, more probative value was apportioned to the pre-separation MEB examination.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261) nor was there any history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions to support a rating under code 5258.  The panel considered other VASRD knee and analogous codes, but all were less applicable and/or not advantageous for rating.  The absence of painful motion would not support any positive degree of impairment, however, IAW DoDI 6040.44, the panel may not recommend a rating lower than that received prior to application.  Therefore, 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’s adjudication for the chronic left knee pain. 

BOARD FINDINGS:  In the matter of the left 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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXXXXXXX:

	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.