RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00132
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Trainee) medically separated for a right knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right knee patella tendonitis” and “medial tibial plateau stress fracture,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic pain secondary to right medial tibial plateau stress fracture” as unfitting, rated 10%, citing application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI contends that her condition has become worse and inhibits her lifestyle.  The complete submission is at Exhibit A.  

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 20071012	VA* – Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain 	5099-5003	10%	Right Knee Patellar Tendonitis, with Pre-Patellar Bursitis	5299-5024	0%	STR	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 1	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20080320 (most proximate to date of separation [DOS])  

ANALYSIS SUMMARY:

Right Knee Condition.  In August 2007, this CI injured her right knee while running.  Magnetic resonance imaging (MRI) showed stress fracture in the medial tibial plateau, and stress changes in the lateral tibial plateau.  She was treated with leg brace, crutches, medication, and physical therapy (PT).  In spite of all treatment efforts, she continued to have problems with her right knee, and an MEB was initiated.  The MEB physical examination (PE) was in September 2007.  The knee pain was judged to be moderate and constant.  PE of the right knee revealed a mild pre-patellar effusion.  There was minimal tenderness to palpation (TTP) of the patella.  The CI had severe discomfort and ecchymosis (bruising) just lateral and superior to the patella.  Active range-of-motion (ROM) testing showed flexion of 125 degrees, and extension of 0 degrees.  All tests for ligamentous laxity were negative, and the distal right lower extremity (RLE) was neurovascularly intact.  On 15 October 2007, the CI was seen in the PT clinic.  She reported that 2 days prior, she had done excessive use of stairs, up and down, and it caused her knee to get worse.  Before that, her knee had been getting better.  PE of the right knee showed TTP and minimal swelling, but no apparent bruising or erythema (redness).  Active ROM testing showed flexion of 80 degrees, and extension of 0 degrees.    

The CI was medically separated from service on 26 October 2007.  She was scheduled for a VA  
Compensation and Pension (C&P) examination in March 2008, but she failed to appear for that exam.  She did have a C&P examination on 25 August 2010, which was 34 months after the date of separation (DOS).  The Board does give 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.  The Board determined that 34 months was too long, and therefore the data from the August 2010 C&P exam had minimal probative value.  The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Right Knee ROM
(Degrees)	MEB ~ 1 mo. Pre-Sep
(20070927)	PT ~ 11 days Pre-Sep
(20071015)	
Flexion (140 Normal)	125	80	
Extension (0 Normal)	0	0	
§4.71a Rating	10%*	10%*	
            		    *10% rating IAW §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion)
								          
The Board directed attention to its rating recommendation based on the evidence.  The Board determined that the best sources of data on which to base a rating recommendation in this case, were the September 2007 MEB exam, and the October 2007 PT exam.  Using clinical information from those two exams; the painful, unfitting right knee condition was essentially non-compensable based solely on the VASRD §4.71a diagnostic codes for loss of knee motion (5260 and 5261).  However; IAW VASRD §4.40, §4.45, and §4.59, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional impairment and functional loss due to painful motion of a major joint.  There was no path to a higher rating for the right knee since there was insufficient evidence of a seriously disabling bone or joint abnormality that would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the chronic right knee pain.  A 10% disability rating was warranted; IAW VASRD §4.40, §4.45, and §4.59.   

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 noted above, PEB reliance on the USAPDA pain policy was operant in this case.  The CI’s chronic right knee condition was adjudicated independently of that policy by this Board.  In the matter of the chronic right knee pain, and IAW VASRD §4.40, §4.45, and §4.59, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  
  
RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.   

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131228, 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 XXXXXXXXXXXXXXXXXX, AR20160000416 (PD201400132)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA