RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05945
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070822

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic right knee pain” with a disability rating of 10%.  

CI CONTENTION:  The knee injury was not updated appropriately.  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 - 20070718	VARD - 20080319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5009-5003	10%	Right Knee ACL and PCL Tears	5299-5257	10%	20071114	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Right Knee Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s right knee condition began prior to entering the Army, but he sustained multiple injuries after enlistment.  Radiographic studies in July 2005 showed a small osteochondroma on the distal femur shaft.  In October 2006, the CI underwent a diagnostic arthroscopy and excision of the osteochondroma.  Post-surgical X-rays showed a normal right knee.  However, an MRI showed a posterior cruciate ligament (PCL) tear, a partial anterior cruciate ligament (ACL) tear, a small joint effusion and a small partially ruptured Baker’s cyst.  The CI declined any further surgical intervention as it was not likely that significant improvement would have been achieved.  The 20 March 2007 physical therapy right knee range of motion (ROM) examination, 5 months prior to separation, showed flexion of 120 degrees (normal 140) and extension of 5 degrees (normal 0).  Pain was noted with overpressure in the right knee with flexion and extension.  Limitation in extension was secondary to soft tissue contracture.  Measurements were performed with a goniometer.  

During the 27 June 2007 MEB examination (recorded on DD Forms 2807-1 and 2808) physical examination, 2 months prior to separation, the examiner noted tenderness, mild edema and positive retropatellar grind.  There was mild anterior/posterior drawer with good end point, but provocative testing for other signs of ligamentous instability was negative.  There was no evidence of meniscal pathology.  At the MEB NARSUM examination, the same day, the CI complained of right knee pain that was worse with movement after sitting, prolonged standing or walking, lifting, impact activities, climbing stairs or walking over uneven surfaces.  Physical examination was unchanged from the MEB examination.  

At the 14 November 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported chronic daily right knee pain with daily flare-ups.  Flares were reported with walking up or downhill, twisting, squatting or bearing weight.  No swelling or locking was reported, but there was occasional give-way.  Physical examination showed “gait and posture normal and stable.  The patient was able to walk on his tiptoes and heels.  Strength 5/5, both proximal and distal muscle groups.”  There was no swelling, redness or warmth, but tenderness was noted to the joint line anteriorly.  Ligament examination was unchanged from orthopedic examination.  Right knee ROM testing showed extension-to-flexion of 0-104 with no change after three repetitions due to pain, weakness or lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, analogously coded 5099-5003 (degenerative arthritis) citing the US Army Physical Disability Agency pain policy.  The VA also rated the right knee condition 10%, analogously coded 5299-5257 (knee, other impairment of) based on the C&P examination, citing subluxation or lateral instability of the knee which was slight.  

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 significant 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, non-union, 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 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 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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXXX

Dear XXXXXXXXXX:

	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.

A copy of this decision has been provided to the counsel you listed on your application.

Sincerely,					      

Enclosure