RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-00813
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20030610

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Infantryman, medically separated for “right knee pain status post debridement of lateral meniscus tear and arthroscopically documented chondromalacia,” with a disability rating of 10%.

CI CONTENTION:  His conditions continue to worsen and negatively impact his daily activities.  The applicant’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 - 20030324	VARD - 20031014	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain Status Post Debridement of Lateral Meniscus Tear	5099-5003	10%	Right Knee Pain with Chondromalacia Status Post Debridement of Lateral Meniscal Tear	5299-5259	10%	20021217	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Knee Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his right knee playing basketball approximately 16 months prior to referral for MEB.  An orthopedic surgery right knee examination revealed a trace effusion (fluid collection), lateral joint line tenderness, and a positive McMurray (assesses menisci) test.  The Lachman (assesses anterior cruciate ligament [ACL]) test was negative.  The examiner reported the magnetic resonance imaging (MRI) was consistent with a lateral meniscal tear.  The CI underwent right knee diagnostic arthroscopy which revealed an old lateral meniscus tear, lateral tibial plateau and femoral condyle chondromalacia (abnormal cartilage softening or degeneration), and extensive synovitis (synovial membrane inflammation).  The surgeon performed debridement of the lateral meniscus tear, minimal chondroplasty (surgical cartilage repair), and a partial synovectomy (surgical synovial membrane excision).  A physical therapy (PT) right knee exam revealed full active range-of-motion (ROM) with painful passive flexion.  There was no effusion and the McMurray test was negative.  Orthopedic surgery performed two local steroid injections into the iliotibial (IT) band (lateral thigh thick connective tissue) which provided minimal relief.  The VA compensation and pension (C&P) examination recounted the history and interventions.  The CI complained of right knee pain since his initial basketball injury, which remained constant following the surgical intervention.  Pain was exacerbated by physical activities, with flare-ups every 2-3 hours, lasting 1-2 hours.  The pain had minimal effects on daily activities and his usual occupation, but caused difficulties with more extreme physical activities.  The physical examination documented a normal posture and gait with no device for ambulation.  There was no sign of abnormal weight bearing on the feet.  The bilateral knee exam was documented as “within normal limits.”  There was no subluxation (incomplete or partial dislocation), locking pain, effusion, or ankylosis (joint stiffening or immobility).  The drawer, PCL and McMurray tests were negative.  The bilateral knee ROM was flexion of 140 (140 normal) and extension of 0 (0) degrees.  There was mild right knee crepitus (grating sensation or sound) and pain with ROM.  The right knee was not additionally limited by fatigue, weakness, lack of endurance, or incoordination.  The right knee X-ray was normal.  The assessment listed status post arthroscopic debridement of a lateral meniscus tear with chondromalacia of the lateral compartment.  The NARSUM performed by orthopedic surgery, 5 months before separation, recounted the history and interventions.  Postoperatively, there was no significant change in the right knee pain and it was essentially back at baseline.  Physical therapy did not provide meaningful relief.  The CI complained he had lateral knee pain and it felt like his knee wanted to "snap" at times.  He was able to sleep approximately 2-3 hours per night before knee pain woke him.  Pain was exacerbated by prolonged standing or sitting.  The CI was taking no medications.  The right knee exam revealed well healed surgical scars with no effusion, edema (excess tissue fluid swelling), or collateral ligamentous laxity.  There was mild lateral joint line and IT band area tenderness.  There was no medial joint line or patellar tenderness.  There was some pain with McMurray testing but not a true positive sign (McMurray's clunk).  The Lachman, pivot shift (assesses ACL), anterior drawer (assesses ACL), and posterior drawer (assesses PCL) tests were negative.  The bilateral knee ROM, measured with a goniometer, was flexion of 130 (140) and extension of 0 (0) degrees.  Strength, sensation, pulses, and deep tendon reflexes (DTRs) were normal.  The examiner recounted the X-ray and MRI findings.  The pain was characterized as frequent and moderate per the pain scale.  The diagnosis listed right knee pain status post debridement of lateral meniscus tear and arthroscopically documented chondromalacia.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis) citing right knee pain, status post debridement of lateral meniscus tear, arthroscopically documented chondromalacia, not taking a narcotic, pain rated as slight and constant, and rated IAW USAPDA pain policy.  The VA assigned a 10% rating under an analogous 5259 code (symptomatic removal of semilunar cartilage) based on the VA C&P examination 6 months before separation.  

The VA cited persistent right knee pain, chondromalacia, status post debridement of lateral meniscal tear, joint crepitus, no evidence of lateral instability, no signs of degenerative joint disease, painful motion, and essentially normal ROM.  The proximate examinations (NARSUM, C&P) did not demonstrate a limitation of motion to support a minimum rating under the limitation of flexion (5260) or extension (5261) codes.  While the CI underwent a debridement of a lateral meniscus tear, there was no removed meniscus for consideration under symptomatic removed meniscus (5259).  There was no dislocated meniscus (5258), knee ankylosis (5256), knee recurrent subluxation/lateral instability (5257), tibia and fibula nonunion/malunion (5262), or genu recurvatum (5263) for consideration under the respective codes.  Board members agreed that there was sufficient evidence of pain with use, as well objective exam findings, to support a 10% rating considering VASRD §4.40 (functional loss) and §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.

BOARD FINDINGS:  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. 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 20140211, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160005607 (PD201400813)

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:  

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA