RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00915
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “degenerative arthritis, right knee,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention in their application.  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 - 20081221	VARD - 20090902	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Right Knee	5003	10%	Surgical Residuals Right Knee	5260	0%	20090218	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:

Degenerative Arthritis, Right Knee. According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a right knee injury in Basic Training and ultimately required arthroscopic debridement and repair of a lateral meniscal tear in December 2006.  Follow-up radiographic imaging in September 2007 showed an osteochondral defect (damage to a piece of cartilage and underlying bone) of the lateral knee joint (tibial plateau) and a lateral meniscal tear.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The CI was placed on a permanent profile and referred for an MEB.  The MEB forwarded “right knee pain secondary to degenerative disease” for PEB adjudication.
At the MEB NARSUM examination on 10 October 2008, (approximately 6 months prior to separation) the CI complained of constant pain and “locking up” of the right knee.  He could perform activities of daily living but could not run.  Physical examination showed right knee flexion of 125 degrees (normal 140 degrees) and extension 0 degrees (normal 0 degrees).  Knee ligaments were intact.  The examination did not mention knee swelling, locking or evidence of meniscus abnormality.

At the VA Compensation and Pension (C&P) examination on 18 February 2009 (1 month before separation) the CI reported right knee pain that was precipitated by physical activity and inclement weather, and relieved by rest and medication.  Dislocation or subluxation was denied.  
Examination showed a normal gait.  There was no swelling of the right knee, but tenderness was present.  There was no ligamentous instability and no mention of objective evidence of knee locking.  Right knee flexion was 130 degrees and extension was 0 degrees.  There was no change in range of motion (ROM) with repetition and painful motion was absent.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10% coded 5003 (arthritis, degenerative), citing limitation of motion.  The VA rated the right knee condition 0% under the 5260 code (leg, limitation of flexion), citing non-compensable ROM and no additional limitations noted with repetition.  The Board agreed there was no limitation of motion which attained a minimum 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 §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The 5259 code (cartilage, semilunar, removal of, symptomatic) provided an alternate route to a 10% rating.  The 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) to support a rating under the respective codes.  Finally, due to the radiographic evidence of an osteochondral tibial plateau lesion, the Board deliberated if the next higher 20% rating was warranted under the 5262 code (tibia, impairment of) for malunion of the tibia with moderate knee disability.  Board members concluded that the evidence at hand was not consistent with this descriptor, therefore a higher rating was not supported via this pathway.  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 20140204, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160010962 (PD201400915)

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