RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05595
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090423

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Cavalry Scout, medically separated for “limitation of extension, right knee” with a disability rating of 10%.  

CI CONTENTION:  “Still having issues and pain has gotten worse along with deterioration of right knee.”  In addition, he requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and 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’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 - 20090211	VARD – 20090506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Limitation of Extension, Right Knee	5261	10%	Patellofemoral Syndrome of the Right Knee	5299-5260	10%	20090418	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Right Knee Limitation of Extension.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a traumatic right patella dislocation in 2004 and underwent A right knee arthroscopy with a lateral release in September 2007 for multiple patella dislocations and chronic anterior knee pain.  The 23 July 2008 MEB physical therapy (PT) range of motion (ROM) evaluation, 9 months prior to separation, showed painful right knee flexion to 130 degrees (normal 140) and extension to -10 degrees (normal 0), and limitation due to scarring.  The 10 November 2008 MEB NARSUM examination, 5 months before separation, noted CI complaints of right knee pain with any kind of running, jumping activity, lifting or carrying any significant weight.  The examiner documented normal posture and gait with no abnormalities, and cited the MEB PT ROM measurements with no limitation from pain, fatigue or weakness.  

At the 18 April 2009 VA Compensation and Pension (C&P) examination, 5 days before separation, the CI reported right knee pain.  Physical examination showed a normal gait with no tenderness or weakness.  Painful right knee ROM showed flexion of 110 degrees and extension of 0 degrees.  Knee X-rays were negative and the CI was diagnosed with patellofemoral syndrome.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5261 (leg, limitation of extension) citing flexion at 130 degrees, extension at -10%, and negative Lachman’s and drawer testing.  The VA rated the right knee condition 10%, analogously coded 5299-5260 (leg, limitation of flexion), based on the C&P examination, citing pain with limited flexion.  Panel members noted that that MEB PT evaluation recorded right knee extension limited to -10 degrees supporting a 10% rating under code 5261, as adjudicated by the PEB.  Although this was not a consistent finding, the PT and April 2009 VA examinations both documented objective evidence of limited motion (scarring and pain respectively) to alternatively support the 10% rating.  There was no limitation of flexion that supported a rating under the VASRD diagnostic code for limitation of flexion (5260); no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); no history of surgery to remove a meniscus (5259); and 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).  No additional functional limitation was evidenced by the examinations, thus there was no higher rating than 10% available under any applicable VASRD 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 §4.71, 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.

PD-2017-05595

XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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.

					PD-2017-05595