RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00471
BRANCH OF SERVICE:  Army	BOARD DATE:  20150616
SEPARATION DATE:  20070630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Pharmacy Technician) medically separated for right knee pain.  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 “chondromalacia of the right knee” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (anxiety NOS) for PEB adjudication.  The Informal PEB adjudicated the right knee condition as “Fit for Duty.”  The CI appealed to the Reconsideration PEB which adjudicated the “chronic right knee pain secondary to chondromalacia and repetitive strain injury, status post diagnostic arthroscopy, degenerative cartilage seen on MRI” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting.   The CI made no further appeals and was medically separated.

CI CONTENTION:  “My right knee was injured during AIT in 2005; surgery was performed in late 2006.  To this date, I still have pain, swelling and decreased range of motion due to my service connected injury when the pain becomes unbearable, I go to a chiropractor; this becomes expensive.”

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 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:

Recon IPEB – Dated 20070522	VA* - (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	Severe Chondromalacia of Patella, Right Knee 	5260-5014	10%	20070508	
Other x 1 (Not In Scope)	Other x 1	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070806 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Knee Condition.  The CI first injured her right knee while running in August 2005.  Recurring pain was evaluated with imaging studies, which showed degenerative changes (chondromalacia) of the undersurface of the patella (kneecap).  On 3 November 2006 a right knee arthroscopy was performed.  The majority of the patella was found to be affected by chondromalacia, which was treated with abrasion chondroplasty and microfracture techniques.  Because the patella was noted to track laterally, a surgical release was performed to promote normal tracking.  Post-operatively, knee pain was insufficiently relieved by conservative management.

The narrative summary on 20 March 2007 (3 months prior to separation) reported continuing knee pain and swelling exacerbated by prolonged walking, standing or driving.  Examination of the right knee showed no swelling.  Painful extension and tenderness were present, but there was no ligament instability.  An examination by physical therapy on 28 March 2007 noted the anterior cruciate ligament to be intact.  At an orthopedic follow-up evaluation on 29 March 2007, the CI continued to complain of constant right knee pain.  Although the condition was noted to be improved since surgery, painful motion and knee tenderness were still present.

At the VA Compensation and Pension exam performed 2 months prior to separation, the CI reported constant anterior knee pain exacerbated by any pressure, climbing stairs or walking.  Swelling and an occasional feeling of instability were also reported, but locking or use of assistive devices was denied.  Examination showed a normal gait.  There was no right knee swelling.  All right knee ligaments were intact and a test for meniscal damage was negative.

The goniometric range-of-motion (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.

Right Knee ROM
(Degrees)	MEB PT ~3 Mos. Pre-Sep	VA C&P ~2 Mos. Pre-Sep	
Flexion (140 Normal)	136, 137, 139	130	
Extension (0 Normal)	0, 1, 1*	0	
Comment	+Painful motion	+Tenderness, painful motion	
§4.71a Rating	10%** (PEB 0%)	10%** (VA 10%)	
		*Hyperextension
	                  **Conceding VASRD §4.40 (functional loss) or §4.59 (painful motion)

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA chose different coding options for the condition, but this did not bear on rating.  The PEB assigned a 0% rating under an analogous 5003 code (degenerative arthritis), while the VA rated at 10% using a combination 5260-5014 code (limitation of flexion; osteomalacia).  Although there was no compensable limitation of motion, there was sufficient evidence of pain with use (§4.40, “functional loss”) and painful motion (§4.59) to justify a minimal compensable rating under §4.71a.  The Board could find no support for rating higher than 10% under alternate knee codes.  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 pain 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 chronic right knee pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 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 her prior medical separation:

CONDITION	VASRD CODE	RATING	
Chronic Right Knee Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140106, 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 XXXXXXXXXXXXXXXXXXXX, AR20150015846 (PD201400471)

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						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA