RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2014-00838
BRANCH OF SERVICE:  Army	BOARD DATE:  20140709
SEPARATION DATE:  20080813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E5 (11B/Infantry) medically separated for a right knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and underwent a Medical Evaluation Board (MEB).  The right knee condition, characterized as “right knee degeneration and right knee pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “painful limitation of motion of the right knee following ACL reconstruction” as unfitting, rated 10%, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was separated.

CI CONTENTION:  “The reason I believe my rating should be changed is because the only test that was ever issued was a range of motion.  I believe if I would have been tested on my lateral movements to the left and right being my biggest issue for me since being separated, they would have seen it was more severe than the percentage I was granted.  It is hard to play any sports with family & friends due to this issue.  Also there was never a weight bearing exam done and this is also a big issue for me when walking upstairs or standing long periods of time and knee giving out during these activities.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right knee condition is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – dated 20080221	VA – 2 mos. Pre-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5260	10%	Right Knee Condition	5260-5024	10%	20080626	
Other x 0 (Not in Scope) 	Other x 6	20080626	
Combined:  10%	Combined:  40%	
	     Derived from VA Rating Decision (VARD) dated 20080827 (most proximate to date of separation)

ANALYSIS SUMMARY:

Right Knee:  In 2003, this CI injured his right knee while playing football.  He underwent anterior cruciate ligament (ACL) reconstruction and medial meniscus repair.  After surgery, he did well and was able to continue with his duties.  In May 2007, while in Iraq, he suffered another right knee injury.  Arthroscopy was done, which showed re-injury of the right medial meniscus.  In spite of all treatment efforts, the CI’s knee problems persisted, and an MEB was initiated.  The MEB narrative summary was dictated on 17 January 2008.  The CI complained of right knee pain, but denied any instability or locking.  Physical exam (PE) of the right knee revealed no erythema (redness) and no effusion (increased fluid in the joint).  There was some medial joint line tenderness noted.  The knee was stable to varus/valgus stress.  The Lachman’s test was stable and posterior drawer sign was negative.  The right leg was intact neurovascularly, with normal motor strength.  Range-of-motion (ROM) was 0-135 degrees.  Two months before separation, the CI had a VA Compensation and Pension exam.  PE of the right knee revealed no ligamentous instability.  McMurray’s test was negative.  ROM was measured and is shown in the chart below.

Right Knee ROM
(Degrees)	MEB ~ 30 weeks Pre-Sep
(20080117)	VA C&P ~ 7 weeks Pre-Sep
(20080626)	
Flexion (140 Normal)	135	140	
Extension (0 Normal)	0	0	
Comment	no mention of pain with motion	painful motion	
§4.71a Rating	0%	10%*	
	*10% based on VASRD §4.40 (Functional loss), §4.45 (The joints), and §4.59 (Painful motion) 

The Board carefully examined all available evidence and directs attention to its rating recommendation.  The Army PEB and the VA chose similar coding options for the right knee condition and both assigned a rating of 10%.  The Board considered the results of the two ROM examinations shown above.  At both exams, the CI had 135 (or greater) degrees of right knee flexion, with no significant evidence of ligamentous instability.  After a thorough review of the record, the Board determined that the right knee condition was essentially non-compensable based solely on the VASRD §4.71a codes for limitation of knee motion (5260 and 5261).  However; IAW VASRD §4.40, §4.45, and §4.59, a part of the musculoskeletal system which becomes painful on use must be regarded as seriously disabled.  A rating of 10% is warranted when there is satisfactory evidence of functional limitation due to painful motion of a major joint.  After reviewing the evidence, all Board members agreed that a rating of 10% was appropriate for the right knee condition.  The Board tried to find a path to a higher rating, using other codes which could be applied to the knee condition.  The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a disabling knee condition which would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the right knee condition.  IAW VASRD §4.40, §4.45, and §4.59, the right knee meets criteria for a 10% rating due to painful motion of a major joint.

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 right knee condition and IAW VASRD §4.40, §4.45, and §4.59, 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140219, w/atchs
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 AR20150006627 (PD201400838)

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						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA