RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxx	CASE:  PD-2017-05669
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve 02, Signal Officer, medically separated for “chronic right knee pain”  with a disability rating of 10%.  

CI CONTENTION:  Right knee condition should have been rated higher.  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 - 20050929	VARD - 20061205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	Chondromalacia with Recurrent Synovitis, Right Knee	5024-5260	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s chronic right knee pain began while playing intramural football where he fell and pulled the posterior right knee ligaments.  Evaluation showed an osteochondroma on the distal lateral femur, which was resected in January 1998.  For the next several years, the CI underwent rehabilitation therapy.  In June 2003, X-rays of the right knee showed irregularity of the posterior distal femur metaphysis, secondary to an old surgery.  An MRI in August 2003 showed moderate-sized joint effusion, some slight thickening of the patellar tendon near attachment to the tibial tubercle, and an area of increased signal in the patella with adjacent articular cartilage irregularity associated with the lateral patellar facet joint.  No surgery was recommended and the CI was placed on a permanent L-3 profile with no running.  

During the 13 May 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported knee swelling, giving way and locking.  Physical examination revealed decreased range of motion (ROM) with pain on motion.  The 1 June 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued chronic discomfort affecting the gait, ability to stand, squat, stoop, and other activities.  He wore a knee brace for support, which prevented the knee from “giving out.”  Physical examination showed tenderness along both medial and lateral aspects of the knee with ROM limited to 90 degrees flexion.  Gait was altered, favoring the right knee and a slight limp was noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right knee condition 10%, analogously coded 5099-5003 (degenerative arthritis) citing ROM at 90 degrees on the right knee with slight/constant pain.  The VA also rated the right knee condition 10%, dual coded 5024-5260 (tenosynovitis-leg, limitation of flexion) based on the STR examination, citing healing injury with arthritis.  

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 evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45) as adjudicated by the PEB.  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), to support a rating under the respective codes.  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).  There was therefore no VASRD §4.71a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 chronic right knee condition.  

BOARD FINDINGS:  In the matter of the chronic 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.  

ARXXXXXXXXXXX, 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.

Sincerely,					      

Enclosure