RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00467
BRANCH OF SERVICE:  Army	BOARD DATE:  20150128
SEPARATION DATE:  20071101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Information Systems Analyst) medically separated for chronic right knee pain.  The knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty although he was authorized to perform alternate physical fitness testing.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  Chronic right patella tendonitis (status post rupture and repair) and loss of motion 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 of the right knee as unfitting rated 20%, citing criteria of US Army Physical Disability Agency (USAPDA) pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Should be changed to medical retirement”

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 20071011	VA* - (1 Week Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain of the Right Knee	5099-5003	20%	Patellar Ligament Injury, Right Knee	5019-5260	0%	20071206	
Other x 0 (Not In Scope)	Other x 2	
Combined:  20%	Combined:  10%	
*Derived from VA Rating Decision (VARD) dated 20080214 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Right Knee Condition.  The CI injured his right knee while playing basketball on two separate occasions.  The first was diagnosed as soft tissue injury in December 2002 and the second was diagnosed as a ruptured patellar tendon in March 2005.  On 30 March 2005, he underwent a non-complicated surgical repair of the detached tendon.  Approximately 4 months after surgery, the CI exhibited a completely normal knee examination.  In January 2007, 10 months prior to separation, his right knee pain returned despite being on limited activity.  The examiner assessed the new onset of pain was due to retained surgical hardware and recommended removal.  Surgical removal of retained hardware was performed on 7 June 2007.  He received a permanent profile in September 2007 and was referred for MEB.  At the narrative summary examination of 6 August 2007 (4 months prior to separation), the CI reported daily right knee pain and an inability to participate in high impact activities, standing greater than 15 minutes, or sitting greater than 30 minutes.  His physical examination (PE) revealed a stable right knee.  There was swelling and tenderness about the bottom of the right patellar tendon and mild atrophy in the right quadriceps muscle.  Range-of-motion (ROM) was normal excepting right knee flexion of 100 degrees.  A right-sided antalgic gait was present.  There was no comment with regards to painful motion.  His diagnosis was chronic right patella tendonitis (status post rupture and repair) and loss of motion.  At the VA Compensation and Pension examination of 6 December 2007 (a week after separation), the CI’s “review of systems” indicated “none” for symptoms in either lower extremity.  He was “able to do all activities of daily living (ADL’s).”  The PE revealed a normal gait and painful limited ROM.  There was no evidence of instability.  The examiner noted ‘no significant effects’ in regards to general occupational activities.

The goniometric ROM 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.

DOS 20071129
Right Knee ROM
(Degrees)	PT (ROM) for MEB
~2 Mo. Pre-Sep
(20070911)	VA C&P
~1 Week Post-Sep
(20071206) 	
Flexion (140 Normal)	(100) 100/103/100	90	
Extension (0 Normal)	-6/-6/-6	0	
Comment	Painful motion;
(+) tenderness;
(+) swelling;
(+) quad atrophy;
(+) antalgic gait	Normal gait;
painful motion	
§4.71a Rating	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under an analogous 5003 code (degenerative arthritis).  Using an analogous dual code 5019-5260 (bursitis-limited flexion), the VA assigned a 0% rating citing non-compensable impaired ROM.  Although the ROM values remained fairly consistent and VASRD non-compensable in both prior and after separation examinations, it was their physical findings that were drastically different and inconsistent.  Board members determined that the clinical differences in the above exams would not equate to a VASRD impairment rating higher than the PEB’s 20%.  After due deliberation in consideration of the evidence and VASRD §4.3 (reason doubt), there was insufficient cause to recommend a change in the PEB adjudication 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, PEB reliance on the USAPDA pain policy for rating the right knee was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the right knee condition and IAW VASRD §4.71a, 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 20140102, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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, AR20150008508 (PD201400467)

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:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA