RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00853
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040701

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a mobilized Army Reserve E3, Administrative Specialist, medically separated by the Informal Physical Evaluation Board for “chronic knee pain,” with a disability rating of 0%.  

CI CONTENTION:  The applicant contends she is unable to do activities she could do before she joined the military.  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 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 - 20040504	VARD - 20060216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Knee Pain	5099-5003	0%	Right Knee Swelling/Pain	5099-5014	NSC	STR	
Major Depressive Disorder	Not Unfitting	Depression	9434	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), dated in March 2004, the CI’s knee condition began in February 2003 during her mobilization to Iraq.  At the NARSUM examination, 3 months prior to separation, the CI reported occasional swelling, aggravated by walking and stair climbing.  She could not perform the aerobic component of the Army Physical Fitness Test and could not carry a backpack or road march without increasing pain and swelling.  A physical examination, dated 24 November 2003, showed tenderness over the pre patellar area with positive grind test (pain in the patellofemoral joint) and marked genu valgum (“knock knees”) bilaterally.  An orthopedics exam, dated 12 March 2004, noted a range of motion (ROM) to 120 degrees, negative Lachman’s, drawer, pivot/shift tests (stability tests) and no laxity.  She had an abnormal Q angle of 23 degrees with increased tibial torsion, a negative apprehension test and significant tenderness along the medial and lateral patellar facets.  Magnetic resonance imaging (MRI) of the right knee in November 2003 showed mild chondromalacia patella with a small cyst.  She was doing clerical work within her current Military Occupational Specialty (MOS).  

The commander’s statement noted she received conservative management of the right knee pain with little benefit.  She was able to perform duties as required of a soldier in her grade, MOS, and current assignment as mostly information management in an office setting.  Her profile did not cause missed performance of duties.  She was limited in her ability to participate in physical training and any field training.  

The CI failed to report for a scheduled VA Compensation and Pension (C&P) examination on 14 October 2005.  The VA noted the available service treatment records (STR) only noted a visit to orthopedics.  The VA rendered their rating decision the right knee pain was not service connected.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under analogous 5099-5003 code (Arthritis, degenerative (hypertrophic or osteoarthritis), citing a rating analogous to degenerative arthritis without loss of motion or positive X-rays.  The VA, using an analogous 5099-5014 code (Chondromalacia patella) based on the STR, determined the condition was not service-connected and not incurred or caused by service.  Routes to a higher rating were considered, but the alternate knee codes 5260 (leg, limitation of flexion), 5261 (leg, limitation of extension), 5258 (cartilage, dislocated) and 5259 (cartilage, removal of) provided no such avenue.  However, there was MRI evidence of right knee pathology and the P3 profile restricted aerobic activity due to the sequellae of pain and swelling.  The commander noted the CI’s condition limited participation in training exercises.  The Board determined the application of functional loss (4.40) was appropriate.  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 chronic right knee pain condition.  

Major Depressive Disorder (MDD).  The Board’s main charge is to assess the fairness of the PEB’s determination that major depressive disorder was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  

The psychiatric NARSUM examination noted the CI had become mildly depressed during adolescence but did not have significant symptoms until after her son’s birth 3 years previously.  She was treated with medication for depression that was helpful.  In August 2003 she was treated with a different medication for depression.  On one occasion she made statements about suicide she said she did not mean.  She overdosed in May 2002 when she and her husband discussed separation.  At the NARSUM she reported sleep disturbance, decreased energy and appetite.  Her mental status examination was essentially normal.  A diagnosis of MDD was rendered with Global Assessment of Functioning (GAF) of 67 (mild symptoms, impairment).  The examiner noted her psychiatric condition was not unfitting and not a boardable condition and her MDD would mildly negatively impact her social and industrial adaptability.

The MDD was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance-based evidence from the record that the depressive disorder condition significantly interfered with satisfactory duty performance.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability ratings are recommended.  

BOARD FINDINGS:  

In the matter of the chronic right knee pain condition, the Board recommends a disability rating of 10%, coded 5099-5003, IAW VASRD §4.71a.  In the matter of the MDD condition, the Board recommends no change from the PEB determination as not unfitting.  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 his prior medical separation:  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140218, 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, AR20160006650 (PD201400853)

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