RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01623
BRANCH OF SERVICE:  Army 	SEPARATION DATE: 20090714  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Individual Ready Reserve E5, Water Treatment Specialist, medically separated for “osteoarthritis, right knee,” with a disability rating of 10%.  

CI CONTENTION:  The conditions continue to worsen and negatively impact daily activities.   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 - 20090506	VARD - 20110908	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteoarthritis, Right Knee	5003	10%	Degenerative Osteoarthritis, Right Knee	5261	30%	20110204	
Osteoarthritis, Left Knee	Not Unfitting	Bi-compartmental Arthritis with Meniscal Degeneration and Joint Effusion of the Left Knee Associated with the Right Knee 	5010-5260	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Osteoarthritis of the Right Knee.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had right knee surgery on three occasions prior to separation.  The first was in December 1996, the second in September 2007, and the third in August 2005.  At an orthopedic visit on 14 April 2008, 15 months before separation, the CI reported knee pain with weight bearing.  On examination she had “good” range-of-motion (ROM) of the knees, with crepitus on motion and diffuse tenderness.  The arthroscopic portals were well healed.  In spite of all treatment efforts, her knee pain did not improve sufficiently to allow unrestricted duty, and she underwent an MEB.  The MEB forwarded “osteoarthritis, bilaterally, right greater than left” for PEB adjudication.  

At the MEB orthopedic NARSUM examination on 5 March 2009, performed 4 months before separation, the CI reported 7-8/10 right knee pain, 1-10 at rest increasing with standing 10-15 minutes, sitting 15-20 minutes or walking about 2 blocks.  Additionally she indicated she could not kneel, perform squats or negotiate more than 1 flight of stairs.  On examination there was mild effusion and tenderness to palpation (TTP) along the anterior and medial aspects of the right knee with some generalized laxity of the medial collateral ligament compared to the left.  Anterior drawer and Lachman’s test for anterior cruciate ligament (ACL) instability were negative.  Flexion was 120 degrees (140 normal), and extension was normal.  

At an orthopedic visit on 23 December 2009, performed 5 months after separation, the CI reported clicking and catching with pain on weight bearing.  On examination the knee was stable to varus stress, for lateral collateral ligament instability, and valgus stress, for medial ligament instability, as well as anterior and posterior stress for ACL and posterior cruciate ligament instability respectively.  Knee strength was good.  Flexion was approximately 100 degrees (140).

At the VA Compensation and Pension (C&P) examination on 4 February 2011, performed 19 months after separation, the CI reported right knee pain, stiffness, swelling and giving way.  On examination there was painful motion and an abnormal gait.  There was no effusion, instability, tenderness or guarding.  The ROM was flexion of 130 degrees with extension of -20 degrees.  There was no decrease in ROM after repetition. 

The Board directed attention to its rating recommendation based on the evidence.  The PEB rated the right knee condition 10%, coded 5003 (degenerative arthritis), citing evidence of painful motion.  In a VA rating decision (VARD) dated 16 February 2007, the VA used VASRD code 5010-5260, and assigned a 10% rating.  Four years later, in a subsequent VARD dated 8 September 2011, the VA increased the right knee rating to 30%, coded 5261 (leg, limitation of extension).

Using data from the knee examinations closest to the date of separation, the Board found insufficient evidence of limitation of motion to justify a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261); however, there was sufficient evidence of painful motion with functional loss, supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The examinations closest 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). 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).  There is therefore no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any applicable code, and no grounds for additional rating based on the presence of instability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the osteoarthritis of the right knee.  

Osteoarthritis of the Left Knee.  The Army PEB adjudicated the left knee condition as: “Not unfitting and therefore not ratable.”  The Board’s main charge with regard to the left knee is to assess the fairness of the PEB’s adjudication.  The left knee condition was profiled, and was judged by the MEB to fail retention standards; however, there was insufficient performance-based evidence from the record that the osteoarthritis of the left knee significantly interfered with satisfactory duty performance.  After due deliberation, and consideration of the evidence, the Board found insufficient cause to recommend a change in the PEB fitness determination for the left knee condition.  

BOARD FINDINGS:  In the matter of the osteoarthritis of right knee, and IAW VASRD §4.40, §4.45 and §4.59, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended osteoarthritis of left knee, the Board unanimously 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, 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 20140311, 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 XXXXXXXXXXXXXXXXXXXXXXX AR20160010520 (PD201401623)

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