RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05609
BRANCH OF SERVICE:  army	SEPARATION DATE:  20050902

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Network Switching System Operator/Maintainer and Avenger Crewmember, medically separated for “chronic right knee pain” with a disability rating of 0%.

CI CONTENTION:  Review requested 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 - 20050526	VARD - 20051020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Right Knee Chondromalacia	5299-5014	10%	20050615	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Chronic Right Knee Pain.  According to the MEB NARSUM and service treatment record the CI’s right knee condition began after parachute jumps in 1996 and was treated conservatively until 2004 before the CI was entered into the MEB process.  There was no surgical indication.  It was noted, “On 13 May 2004 he was seen again and at this point an MRI had been ordered and the results were thought to be of no significant abnormality.”  During the 17 August 2004 MEB specialty care examination, 13 months prior to separation, the CI reported right knee pain.  Physical examination revealed very mild bilateral knee crepitation.  There was no deformity, effusion, and no cysts or other significant abnormalities.  Meniscus impairment and instability testing were negative.  Bilateral knee range of motion (ROM) was “full.”  Painful motion was not addressed.  The physician stated, “He [CI] does not have a significant orthopedic diagnosis in terms of his right knee:  however, he has not been capable of performing his duties for the last few years in the service.”  

At the 14 March 2005 MEB NARSUM examination, 6 months before separation, the CI reported right knee pain.  Physical examination showed right knee tenderness, no swelling, and negative laxity and meniscus impairment testing.  Strength was normal. The 25 March 2005 MEB physical therapy (PT) examination measured right knee flexion to 145 degrees (normal 140) and extension was 0 degrees (normal) with painful motion.

At the 20 October 2005 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported wearing a knee brace for constant right knee pain and weakness, and a Baker’s cyst (fluid-filled cyst behind the knee).  He denied any incapacitations or lost work time due to the condition. Physical examination showed the gait, posture and general appearance of the knee within normal limits.  Leg lengths were equal and there were no signs of abnormal weight bearing.  There was right knee crepitus, and meniscal impairment and instability tests were negative.  Right knee flexion was 120 degrees and extension was 0 degrees with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing full ROM, normal X-ray, and only one joint involved.  The VA rated the right knee condition 10%, analogously coded 5299-5014 (osteomalacia), based on the C&P examination, citing painful motion.  The panel agreed 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 satisfactory evidence of painful motion with functional loss to support a 10% rating (based on §§4.59, 4.40 and 4.45), as reported on the MEB PT and VA ROM examinations.  There was no evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), no history of cartilage (meniscus) “removal” surgery (5259), or fracture, nonunion or malunion of the femur or tibia causing a knee impairment (5255, 5262) to support a higher rating under those codes.  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 right knee condition, coded 5299-5260.

BOARD FINDINGS.  In the matter of the right knee condition, the panel recommends a disability rating of 10%, coded 5299-5260 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 Right Knee Pain	5299-5260	10%	

PD-2017-05609

XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

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. 

PD-2017-05609