RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX	CASE: PD-2013-01830
BRANCH OF SERVICE:  Army	BOARD DATE:  20150326
SEPARATION DATE:  20060210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Unit Supply Specialist) medically separated for left knee pain.  The left knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Osteoarthritis of the left knee with diffuse chondromalacia” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic left knee pain” as unfitting, rated 0% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “When I received my rating my paperwork went to Walter Reed and came back in ‘two days’ with a rating of 0%.  The VA gave me rating of 10% during my medical out processing with them.  The explanation was that knees only were priority at 0% to 10%, and they gave me the lowest possible rating.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

IPEB – Dated 20051129	VA*  ~1 Month Pre-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5003	0%	Osteoarthritis & Chondromalacia,
Left Knee	5010-
5260	10%	20051228	
Other x 0 (Not In Scope)	Other x 1	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060726 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Left Knee Pain.  The narrative summary notes the CI had a history of knee pain following a twisting injury and aggravated it 3 years later in November 2002 while walking.  Magnetic resonance imaging on 30 August 2002 noted medial and lateral meniscus tears, sprain of the medical collateral ligament, chondromalacia of the medial femoral condyle, and a ganglion cyst near the posterior cruciate ligament.  Surgery was recommended but the CI was preparing for deployment.  Following his return from deployment the CI reported worsening knee pain and X-rays showed osteoarthritis.  An orthopedic evaluation on 4 April 2005 noted tenderness along the medial joint line and positive testing for meniscal injury (McMurray’s), without instability and recommended surgery.  Arthroscopy on 14 April 2005 was performed with repair of medial and lateral meniscus tears, debridement, and repair of Grade III-IV chondromalacia of the knee and Grade II of the patella.  Following the surgery the CI continued to report knee pain and an MEB was initiated.

At the MEB examination on 18 August 2005, 6 months prior to separation, the CI reported knee pain, aggravated by activity, and swelling after prolonged walking.  The MEB physical exam noted joint line tenderness without effusion.  There was pain with patellar compression and McMurray’s maneuver.  Knee range-of-motion was 0-120 degrees (normal 0-140).  Lower extremity strength and sensation were normal.  The DD Form 2808, Report of Medical Examination performed the same day, noted swelling and pain with flexion greater than 45 degrees.

At the VA Compensation and Pension examination on 28 December 2005, a month prior to separation, the CI reported knee pain.  The exam noted a normal gait.  Knee ROM was full with pain at 130 degrees of flexion.  There was a mildly positive McMurray’s sign and no evidence of instability.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition 0%, coded 5003 (degenerative arthritis) and the VA rated it 10%, coded 5010-5260 (limited flexion with traumatic arthritis).  The evidence in record supports a 10% rating coded with any of multiple §4.71a codes-5503 for painful limited motion of a single joint with imaging evidence of degenerative arthritis; 5260 IAW VASRD 4.59 (painful motion); or 5259 for symptomatic semilunar cartilage.  The Board reviewed to see if a higher evaluation was achieved with any coding approach.  There was no evidence of ankylosis; instability or dislocation; frequent “locking”, joint pain and effusion into the joint; impairment of the tibia/fibula or femur; or sufficient limitation of ROM to provide higher or additional rating of the knee.  Members agreed that the disability due to the knee condition did not meet rating criteria for a rating higher than 10% with any applicable code and chose to code as 5003.  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.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5003 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:

CONDITION	VASRD CODE	RATING	
Left Knee Osteoarthritis	5003	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131024, 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, AR20150011066 (PD201301830)

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:

Encl			

CF: 
(  ) DoD PDBR
(  ) DVA