RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00757
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a mobilized Army National Guard E4, Military Police, medically separated for “left knee pain” with a disability rating of 0%.

CI CONTENTION:  The applicant contends he can no longer get a job in his Army career field.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 PEB - 20040614	VARD - 20040524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee Pain	5099- 5003	0%	Left PFS …	5299-5260	10%	20031216	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:  

Left Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in June 2003 after running during physical training without a specific injury.  A magnetic resonance imaging (MRI) in June 2003 showed a defect in the kneecap, but was otherwise unremarkable.  Despite treatment, the left knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left knee patellofemoral pain, medio-patellar facet osteochondral lesion,” for PEB adjudication.  The 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. 

Left Knee ROM
(Degrees)	VA C&P ~9 Mos. Pre-Sep	MEB ~7 Mos. Pre-Sep	PT ~4 Mos. Pre-Sep	
Flexion (140 Normal)	110	130	108, 109,108	
Extension (0 Normal)	0	0	0	
Comment	Mild crepitus and some anterior instability	Antalgic gait		
§4.71a Rating	10%	0%	0%	

At the VA Compensation and Pension (C&P) examination on 16 December 2003, performed 9 months before separation, the CI reported he had “pain all day, every day” and the left knee swelled, locked, popped and grinded.  Physical examination showed slightly decreased ROM in the left knee as noted above with normal motor strength and “no diminution in either of these with repetitive testing.” The examiner also noted the CI did not use a knee brace but did use a cane and walked with a limp.  Crepitus (an audible or tactile sense of grating) was present with motion, but painful motion was not recorded.  At the MEB NARSUM on 27 January 2004, 8 months prior to separation, the CI reported pain in the front portion of his knee with activity.  The CI used a cane to assist ambulation.  Examination revealed normal alignment of the entire lower extremity with no obvious swelling in the lower leg, knee or ankle.  He walked with a limp with assistance from the cane.  There was no effusion present and the patella was stable without signs of meniscal irritation.  Patellar tracking was displaced consistent with the diagnosis of left knee patellofemoral pain.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 23 February 2004, 6 months prior to separation, the CI reported left knee pain with movement and that he wore a brace and used a cane.  The examiner noted decreased ROM, “quad atrophy,” and a positive gait.  The CI continued treatment in physical therapy and showed improvement in the quadriceps atrophy in the visits leading up to separation.  Painful motion was documented on 31 May 2004, when doing squats.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5099-5003 code (analogous to degenerative arthritis), citing pain with no evidence of ligamentous laxity.  The VA assigned a 10% rating using the 5260 code (limitation of leg flexion), based on the VA C&P examination 9 months before  separation, citing decreased range of motion as a result of a healed injury.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating based on VASRD §4.59, §4.40 and §4.45.  Although the VA examination demonstrated some mild crepitus and some anterior instability, all other examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258).  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  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 left knee condition, coded 5099- 5003.  

BOARD FINDINGS:  In the matter of the left knee 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.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee Pain	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140210, with attachments
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, AR20160008273 (PD201400757)

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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization 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