RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00134
BRANCH OF SERVICE:  Army	BOARD DATE:  20151104
SEPARATION DATE:  20080125

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Information System Operator-Analyst) medically separated for a right knee injury.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chondromalacia, right knee” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated chondromalacia patella of the right knee as unfitting, rated 0% with likely application of the US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals, and was medically separated.

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  He was not evaluated for a radiculopathy condition.  His 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 20071011	VA* - (~2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chondromalacia Patella, Right Knee	5099-5003	0%	S/P Right Knee Discoid Lateral Meniscus w/Patellofemoral Syndrome	5259	10%	20071212	
			Residual Scars of Right Knee…	7802	0%	20071212	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 4	
RATING:  0%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20081205 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Right Knee Condition.  The narrative summary (NARSUM) notes that the CI had a history of right knee pain treated with two arthroscopic surgeries.  The CI was thought to have a torn lateral meniscus (LM), but at the first arthroscopy, no meniscal tear was found and some abundant lateral soft tissue (plica) was removed.  The CI did not obtain full relief with this procedure and at an orthopedic evaluation, locking and catching of the knee was noted on exam, with joint line tenderness, but no instability.  The orthopedic examiner indicated that magnetic resonance imaging (MRI) of the knee noted a “discoid lateral meniscus,” though he did not see it himself on review of the imaging.  A second arthroscopy was performed on 15 February 2007 and again no joint abnormalities were noted during the procedure except a discoid LM that was “saucerized” in an attempt to reduce the knee pain.  After the second procedure the CI was deployed, but continued to report right knee pain.  At an orthopedic visit, the exam noted no instability or effusion.  There was patellar grinding noted, with full knee range-of-motion (ROM) with pain at end range of flexion and normal strength and sensation of the lower extremity.  Right knee MRI noted findings of a LM tear and possible partial tear of the anterior cruciate ligament, but the orthopedic specialist interpreted the MRI as showing only post-operative changes.  Despite physical therapy (PT), the knee pain continued and medical evacuation and an MEB were recommended.  Many PT visits after the CI’s return indicated persistent right knee pain without mechanical symptoms.  

At the MEB exam 6 months before separation, the CI reported constant right knee pain.  The MEB physical exam noted full ROM of the right knee without tenderness to palpation or instability.  The MEB examiner characterized the CI’s knee pain as “constant and moderate”.  

At the VA Compensation and Pension (C&P) exam a month before separation, the CI reported pain, weakness, stiffness, swelling, giving way and locking of the knee, aggravated by activity.  He reported that he could function with the pain with medication.  The exam noted the CI was wearing a brace on the right knee and walked with a limp favoring the right.  There was guarding of the right knee with movement.  There was no instability, recurrent subluxation, locking pain, crepitus, or ankylosis.  Right knee ROM was extension-flexion 0 to 115 degrees (normal 0 to 140)  There was no additional loss of ROM with repetition.  Right knee X-rays were normal.  The VA examiner noted that the CI was currently having a flare-up and limping.

At a remote VA C&P Joints exam 36 months after separation, the CI reported a third arthroscopic surgery, which was not documented in the records available to the VA examiner.  At the exam the CI reported right knee pain without instability, giving way, locking, or weakness.  The exam noted a normal gait with full right knee ROM.  There was crepitus noted with painful motion, without instability.  The exam noted that MRI noted degenerative joint disease and loss of patellar cartilage.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded 5099-5003 (analogous to degenerative arthritis).  The VA rated the knee condition 10%, coded 5259 (removal of symptomatic semilunar cartilage).  At the 2011 VA C&P exam noted, the CI reported a third arthroscopic procedure was performed 31 months after separation.  The Board notes that this remote VA C&P evidence is outside the 12-month period for special consideration of post-separation VA evidence IAW DoDI 6040.44, and the C&P exam is considered only to the degree that it provides information that reflects the CI’s condition proximate to the date of separation.  In this case, members agreed that this information provided no additional probative evidence for its rating recommendation for the disability due to the knee condition at separation.  The Board agreed the evidence in the available service treatment record and at both the MEB and C&P exam supports a 10% rating of the knee coded as 5259, or coded 5299-5260 (analogous to limited leg flexion) IAW VASRD §4.59 (Painful motion) for limited, painful ROM, which otherwise did not meet a 10% rating based on ROM criteria alone.  The Board reviewed to see if a higher rating was supported with any applicable code.  However, there was no evidence of “frequent episodes of `locking’, pain, and effusion into the joint”; recurrent subluxation or instability; impairment of the tibia, fibula, or femur; or, knee ankylosis to support a higher rating and 10% is the highest rating available for a single major joint or group of minor joints coded according to 5003 criteria.  The Board determined that the evidence supports a 10% rating for the right knee condition and no higher and chose to code the knee condition 5259.  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 right 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.  As discussed above, the PEB may have relied on the USAPDA pain policy for rating the right knee condition and the condition was adjudicated independently of that policy by the Board.  In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5259 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	
Right Knee Chondromalacia Patella Condition	5259	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131230, 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 XXXXXXXXXXXXXXXXXXXX, AR20160000420 (PD201400134)

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