RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01234
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light Wheel Vehicle Mechanic, medically separated for “chronic left knee pain” with a disability rating of 0%.

CI CONTENTION: The applicant writes that his condition continues to worsen and negatively impacts 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 - 20061002	VARD - 20070306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain	5010	0%	Chondromalacia, Left Knee w/ Degenerative Change	5014	0%	20061101	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic 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 August 2003 following a bad landing during airborne operations.  Magnetic resonance imaging (MRI) in January 2004 showed a mild degenerative signal within the posterior horn of the medical meniscus without definite meniscal tear and questionable mild, early chondromalacia of the medial patellar facet with no joint effusion.  Over the next 2 years, the CI deployed twice, but continued to have left knee pain.  An MRI on 5 June 2006 indicated a strain versus a partial tear of the anterior cruciate ligament, prior trauma or inflammation to the anterior tibial tubercle, and mild degenerative changes of the knee.  At an orthopedic visit on 26 June 2006, 7 months prior to separation, it was noted that the CI was involved in a motor vehicle accident a day prior to the visit, hitting his left knee on the dashboard.  Physical examination noted medial joint line tenderness and crepitus over the patella. There was no effusion, instability, or evidence of meniscal pain. The orthopedist indicated the CI was not a surgical candidate.  At the MEB examination dated August 2006, 5 months prior to separation, the CI reported constant knee pain.  Physical examination showed no effusion, or gross crunching, grading or clicking with full flexion and extension.  There was pain with medial stressing and minimal pain with patella compression. The NARSUM, also written in August 2006, identified the same conditions as outlined by the MEB examinations.

At the VA Compensation and Pension (C&P) examination in November 2006, performed 2 months before separation, the CI reported constant aching, sharp pain which was relieved by medication and rest.  The CI did not recall any incapacitation requiring bed rest.  Physical examination showed normal posture and gait and mild crepitus.  There was no edema, effusion, weakness, or tenderness.  There was no evidence of recurrent subluxation, locking pain or joint effusion.  Ligamentous and meniscal tests were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under code 5010 (arthritis, due to trauma), citing only one joint involved.  The VA also assigned a 0% rating using code 5014 (osteomalacia) based on the VA C&P examination 2 months before separation, citing no evidence of painful or limited motion.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5260 or 5261).  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) or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  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).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 10% for the left knee condition, coded 5099-5003.

BOARD FINDINGS:  In the matter of the left knee pain, 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 to medical separation:

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140305, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160006741 (PD201401234)

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: