RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01537
BRANCH OF SERVICE:  Army	BOARD DATE:  20150624
SEPARATION DATE:  20040611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Network Operator Maintainer) medically separated for right knee pain.  The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “right knee instability” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition (gastro-esophageal reflux disease [GERD]) for PEB adjudication.  The Informal PEB adjudicated the right knee condition as unfitting, rated 0% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  He was given a higher rating for his condition by the VA.  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/Naval 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 20040322	VA* - (~1 Mo. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain with Feeling of Instability…	5099-5003	0%	Chronic Right Knee Strain	5099-5019	10%	20040506	
Other x 1 (Not in Scope)	Other x 10	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20040902 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  

Right Knee Condition.  The CI was first evaluated for his right knee condition in 1999 and was diagnosed with a sprained knee.  He was managed conservatively with duty limitations and medications.  He was next seen in 2003 when he complained of a 2-week history of right knee pain after physical fitness testing.  His knee was stable with full range-of-motion (ROM).  Despite conservative treatment, his pain persisted and an magnetic resonance imaging performed on 3 July 2003 showed a normal meniscus, but an abnormal posterior cruciate ligament, one of two which provides stability from front to back.  He was referred to orthopedics and diagnosed with a postero-lateral corner injury.  He was referred to physical therapy (PT) and issued a brace.  His symptoms persisted and he was then issued a permanent L3 profile and referred for MEB.  He did have some motion with varus stress (pushing the knee into a bow-legged condition).  Surgery was discussed, but declined by the CI.  The narrative summary noted the above history and that the knee was stable, but painful to valgus (knock-kneed) stress.  At the MEB examination on 17 February 2004, the exam noted full ROM and a stable knee without signs of meniscal irritation.  He was tender along the posterior lateral joint line.  The ROM in PT on 24 February 2004 showed 0-125 degrees for the right knee and 0-130 degrees for the left knee (VA normal values are 0-140 degrees).  At the VA Compensation and Pension examination performed a month prior to separation, the CI reported right knee pain since March 2003 when he stepped into a hole while running in physical fitness training.  He denied incapacitation or time lost from work, but endorsed difficulty with stairs and walking more than one mile.  He had a limp and used a brace.  The ROM was reduced and painful.  The knee was stable and without an effusion.  The CI was tender along the lateral joint line and his pain increased upon repetition of the ROM.  X-rays were normal.  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)	MEB ~ 3.5 Mo. Pre-Sep	VA C&P ~ 1 Mo. Pre-Sep	
Flexion (140 Normal)	125 (125,125,125)	130 (pain at 110)	
Extension (0 Normal)	0	0	
Comment	Painful motion	Painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee at 0% using the code 5099-5003 (analogous to degenerative arthritis).  The VA rated the knee at 10%, coded 5099-5019 (analogous to bursitis).  The evidence supports a 10% rating for painful motion (VASRD §4.59) using either code.  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.

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 pain condition, 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.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Right Knee Pain	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140331, w/atchs
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 XXXXXXXXXXXXXXXXXXXXX, AR20150018382 (PD201401537)

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,
I accept the Board’s recommendation to modify the individual’s disability rating to 10%
without recharacterization 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