RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01343
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Infantryman) medically separated for osteoarthritis of the right knee, rated at 0%.  

CI CONTENTION:  The CI contends that his condition continues to worsen and he was not evaluated for his Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) conditions.  His complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  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 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:  

IPEB - Dated 20071030	VA* - (5 Days Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis of the Right Knee	5003	0%	Right Knee Osteoarthritis	5014	10%	20080102	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8 	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080425 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Osteoarthritis of the Right Knee Condition.  The first record in evidence for the right knee was a physical therapy (PT) evaluation on 15 April 1999.  The CI reported twisting his knee 2 weeks earlier while playing football.  He was managed with PT, medications, and duty limitations.  He was able to return to duty, but periodically re-injured his knee over the next few years with increased symptoms.  At arthroscopy on 24 April 2007, he was found to have a medial meniscus (cartilage cushion in the knee) tear (MMT) and a lateral meniscus tear (LMT) as well as degenerative joint disease (DJD) and degeneration of the cartilage lining of the knee.  The joint was stable when examined under anesthesia (EUA).  He then had rehabilitation in PT as well as injections with Hyaluronic Acid (a material to cushion the joint), but his pain precluded return to full duty.  He was issued a permanent L3 profile and referred for MEB.  At the MEB examination on 18 September 2007, 4 months prior to separation and 5 months after surgery, the CI reported that walking was painful and that he could not run.  He also noted that the knee buckled.  The MEB physical examiner noted a painful gait, a mild effusion, and decreased flexion and extension with pain.  The narrative summary (NARSUM) was dictated the next day by the orthopedic surgeon.  It noted a minimal effusion with well healed surgical scars.  The range-of-motion (ROM) exceeded VA standards and was not reduced with repetition.  The knee was stable.  Slight quadriceps atrophy was noted.  Compression of the kneecap was painful and crepitus (a grinding sensation or noise when moving the kneecap) was present.  X-rays taken prior to the surgery showed degenerative changes which had also been seen on an MRI and are described above.  He was thought to have right knee osteoarthritis (OA).  Painful motion was not documented.  The VA Compensation and Pension (C&P) examination was performed 5 days before separation.  The CI reported the use of a knee brace and occasional use of a cane.  He was able to accomplish all the activities of daily living.  No ambulatory aids were present on examination, but he did walk with a limp.  The knee was stable, but flexion reduced as charted below.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Right Knee ROM
(Degrees)	PT ~7 Mos. Pre-Sep	Ortho/MEB~4 Mos. Pre-Sep	VA C&P 5 Days Pre-Sep	
Flexion (140 Normal)	110	150, 150, 150	80	
Extension (0 Normal)	0	0, 0, 0	0	
Comment	2 months post op; Motion without pain	Painful motion not recorded	Painful motion	
§4.71a Rating	0%	0%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee at 0%, coded 5003 (degenerative arthritis).  The VA rated the knee at 10% for painful motion, coded 5014 (osteomalacia), but later changed the code to 5261 (limitation of extension) without changing the rating.  The Board noted that painful motion was recorded on the MEB 2808 examination as well as the VA C&P examination.  This supports a 10% rating IAW VASRD §4.59 (painful motion).  There was no indication of a joint locking; the limitation in motion was not compensable; and, the joint was stable.  The Board found no route to a rating higher than 10%.  It noted that the code 5259 (symptomatic removal of a meniscus) was a better description of the clinical picture than the 5003 code chosen by the PEB.  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 right knee condition, coded 5259.  

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, the Board unanimously recommends a disability rating of 10%, coded 5259 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  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	
Osteoarthritis of the Right Knee 	5259	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140314, 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, AR20160003987 (PD201401343)

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