RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00271
BRANCH OF SERVICE:  Army	BOARD DATE:  20150225
SEPARATION DATE:  20060621

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Cannon Crewmember) medically separated for right 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).  The knee condition, characterized as “right knee chondromalacia” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions detailed in the rating chart below for PEB adjudication.  The Informal PEB adjudicated “right knee pain, without neurologic abnormality” as unfitting, rated 10% with application of the US Army Physical Disability Agency (USAPDA) pain policy.  The remaining conditions were determined to be not unfitting.  The CI appealed to the Formal PEB, which affirmed the PEBs findings and ratings.  The CI was then separated.

CI CONTENTION:  “So that other conditions can be known and evaluated,” and “I am rated at 50% for PTSD.”

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:

Service IPEB – Dated 20060323	VA - 4 mos. Pre and 9 mos. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain, without Neurologic Abnormality	5099-5003	10%	Degenerative Joint Disease, Post Medial Meniscal Repair, Right Knee	5259	10%	20060215	
Post-Traumatic Stress Disorder	Not Unfitting	Post Traumatic Stress Disorder	9411	50%	20070314	
Cannabis Dependence	Not Unfitting	No VA Entry				
Major Depressive Disorder	Not Unfitting	No VA Entry				
Other x 0 (Not in Scope)	 Other x 7	
Rating:  10%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20060622 and 20070411 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  

Right Knee Pain Condition.  The CI suffered a right knee injury in October 2004 and experienced pain and swelling.  The swelling required needle aspiration of the fluid for pain control.  He continued to experience pain that increased after running along with catching, popping, locking and giving out.  A magnetic resonance imaging study in July 2005 revealed a tear of the right medical meniscus.  The CI underwent an arthroscopic procedure in August 2005 where a small tear in the medical meniscus was identified along with a “very large” osteochondral defect.  The narrative summary (NARSUM) noted that micro-fracture technique was used to treat that defect.  In spite of post-surgical physical therapy the CI’s knee pain did not resolve.  The NARSUM prepared approximately 4 months prior to separation noted the CI was having pain that was on par or worse than prior to surgery.  He continued to have locking symptoms of the knee with marked crepitus and recurrent effusions.  The pertinent physical exam findings are summarized in the chart below.  At the VA Compensation and Pension exam performed 4 months prior to separation, the CI reported symptoms of 6/10 pain, popping, locking and grinding sensation with precipitating factors of prolonged standing, periods of inactivity or changes in weather.  He experienced flare-ups approximately twice a week which lasted 1-2 hours.

The goniometric range-of-motion evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Knee ROM (Degrees)	NARSUM ~4 Mos. Pre-Sep	VA C&P ~4 Mo. Pre-Sep	
Flexion (140 Normal)	130	135	
Extension (0 Normal)	0	0	
Comment	Pos. tenderness to palpation, effusion & mild atrophy; No instability; Normal strength & sensation	Normal gait; No tenderness to palpation; Pos. crepitus; No instability or Deluca criteria; Normal strength	
§4.71a Rating	10%* (PEB 10%)	10%* (VA 10%)	
*IAW VASRD §4.59

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the right knee pain condition by applying the analogous VASRD code 5099-5003 (degenerative arthritis) and rated it 10% with specific application of the USAPDA pain policy.  The VA applied the code 5259 (symptomatic removal of semilunar cartilage) and rated it 10%, which is the most under that VASRD code.  The Board considered VASRD code 5258, (dislocated semilunar cartilage with frequent episodes of ‘‘locking,’’ pain, and effusion into the joint) which grants a rating of 20%.  The evidence supports that he continued to have crepitus, effusions and locking after the arthroscopic procedure and there was never any evidence of knee instability.  The CI had a “very large” osteochondral defect which is most appropriately rated under VASRD code 5003 and would receive a 10% rating.  The Board considered VASRD §4.7, higher of two ratings, which states, “Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating will be assigned.”  In this case, the CI had known meniscal pathology and post-surgical symptoms of pain, recurrent effusion and locking, all consistent with the symptoms under code 5258 which allows a 20% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the right knee pain condition.

Contended PTSD, Cannabis Dependence, MDD Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that PTSD, cannabis dependence and MDD were not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  None of the contended conditions were profiled or implicated in the commander’s statement and none were judged to fail retention standards.  All were reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.

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 the USAPDA pain policy for rating right knee condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right knee pain condition, the Board unanimously recommends a disability rating of 20%, coded 5258 IAW VASRD §4.71a.  In the matter of the contended PTSD, cannabis dependence and MDD conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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	
Right Knee Pain	5258	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140108, 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 XXXXXXXXXXXXXXXXXXX, AR20150018795 (PD201400271)

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 20% 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