RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01562
BRANCH OF SERVICE:  Army	BOARD DATE:  20141022
SEPARATION DATE:  20041221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92F/Petroleum Supply Specialist) medically separated for left knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Left knee pain secondary to meniscal tear and chondromalacia grade 1/2” conditions, characterized as medically acceptable, were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “left knee pain” which included chondromalacia as unfitting rated 0% with likely reliance on AR 635-40, B29 citing “as analogous to arthritis of one major joint.”

CI CONTENTION:  “BASED ON THE WOUNDED WARRIOR ACT JANUARY 28 2008.” [sic]

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left knee pain condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any condition or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20040826	VA* - (3 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099-5003	0%	Degenerative Changes Left Knee 	5260-5010	10%	20040915	
Other x 0  (Not in Scope)		
Combined:  0%	Combined:  20%	
*Derived from VA Rating Decision (VARD) dated 20041230 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Left Knee Pain with Chondromalacia Grade 1/2 Condition.  The narrative summary noted an initial left knee injury during basic training in 2001 with swelling and intermittent locking symptoms.  He continued training with increasing left knee pain that was not responsive to conservative therapy.  Imaging (magnetic resonance imaging and plain films) demonstrated a lateral meniscus tear and tibial plateau chondromalacia.  Surgery was recommended, but reasonably declined.  Treatment notes from 2002 through April 2004 had sporadically documented full range-of-motion (“FROM”), without evidence of formal goniometric ROM testing or consideration of repetitive motion.

At the MEB exam, 6 months prior to separation, the CI reported continuing left knee pain and recurrent episodes of locking.  The MEB physical exam noted the CI wearing a brace, an antalgic gait and having moderate swelling of the knee.  There was an effusion and a positive McMurray’s test (for meniscal tear) and patellar apprehension.  There was no instability and neurovascular exam was normal with no muscle atrophy noted.  Goniometric ROM performed the same day indicated an ROM of 0-112 degrees (normal 0-140) with pain on motion.  The diagnoses were meniscal tear and chondromalacia of the left knee.

At the VA Compensation and Pension (C&P) exam performed 3 months prior to separation, the CI reported similar history and symptoms.  Exam documented a normal gait with ROM of 0-60 degrees including DeLuca criteria with repetition (normal 0-140).  There was positive crepitus and McMurray’s test.  A second VA C&P exam performed 7 months after separation noted continued use of a brace, significant tenderness and pain on manipulation or motion.  ROM was 0-100 degrees and there was no laxity or effusion noted.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the knee at 0% noting the meniscal tear and chondromalacia and specifying normal ROM without joint laxity.  Coding was coded analogous to 5003 [arthritis, degenerative (hypertrophic or osteoarthritis)].  All formal ROM evaluations in evidence documented painful motion and the Board considered that the PEB may have applied AR 635-40, B29 for rating.  The VA rated the knee at 10% coded 5260-5010 (leg limitation of flexion - arthritis, due to trauma, substantiated by X-ray findings).  All formal exams in evidence proximate to separation documented painful motion below the level for separate compensation under the specific knee flexion or extension ratings.  There was no objective evidence of knee recurrent subluxation or lateral instability and history was consistent with “locking” due to meniscal tear.  The Board therefore considered coding analogously to codes 5258 or 5259 for the semilunar cartilage.  The Board adjudged that the record did not sufficiently support “frequent episodes of ‘locking,’ pain, and effusion into the joint” to warrant a 20% rating under the criteria of 5258.  Although coding analogous to 5259 at 10% was supportable, this rating includes painful motion, and did not offer any benefit to coding as 5260-5010 at 10% with application of VASRD §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left knee condition coded 5260-5010.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on AR 635-40, B29 for rating the left knee was likely operant in this case and the condition was adjudicated independently of that regulation by the Board.  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5260-5010 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Left Knee Pain	5260-5010	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130924, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150007002 (PD201301562)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA