RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01683
BRANCH OF SERVICE:  Army	BOARD DATE:  20150128
SEPARATION DATE:  20060328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Human Resources Specialist) medically separated for a chronic left knee condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3/H2 profile and referred for a Medical Evaluation Board (MEB).  The “left knee patella-femoral pain syndrome” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic left knee pain secondary to chondromalacia” as unfitting, rated 0% citing the US Army Physical Disability Agency policy/Guidance Memorandum #12, dated 28 February 2005, Subject: Table of Analogous Codes.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 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:

IPEB – Dated 20060214	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Knee Pain, Secondary to Chondromalacia	5099-5003	0%	Patellofemoral Syndrome with Chondromalacia, Left Knee	5299-5261	10%	20060710	
Other x 0 (Not In Scope)	Other x 0	
RATING:  0%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060802 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Chronic Left Knee.  The narrative summary (NARSUM) noted the CI sustained an injury to his left knee during a sports activity in June 2004.  A magnetic resonance imaging (MRI) of the knee, demonstrated a tear of the left medical meniscus cartilage (in side knee cartilage between upper and lower leg bones).  A follow-up MRI performed on 7 March 2005, showed no injury.  On an orthopedic evaluation on 12 October 2005, no swelling or tenderness to palpation of the knee was present.  Range-of-motion (ROM) of the knee was “full” without instability.  Crepitus and “grinding” without mention of pain were present on movement of the knee.  A ROM evaluation on 31 October 2005, by physical therapy for the MEB is summarized in the chart below.  At the MEB DD Form 2808 evaluation performed on 15 November 2005, and referenced in the NARSUM evaluation of 23 November 2005, 4 months prior to separation, examination of the knee revealed minimal edema in the area of the patella (knee cap).  Slight tenderness of the patella with no other knee tenderness was reported.  ROM of the knee was normal without instability.  Motor strength and sensation were normal.  Findings on this exam are summarized below.  At the VA Compensation and Pension (C&P) exam performed 4 months after separation, the CI reported no locking, dislocation or subluxation of the knee.  On physical examination, the gait was normal.  Pain, grinding and crepitus were reported on motion of the knee.  Motor strength, sensory and stability exams were normal.  Findings on this exam are summarized 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 below.

Left Knee ROM
(Degrees)	PT/MEB ~5 Mo. Pre-Sep
(20051031) 	VA C&P ~4 Mo. Post-Sep
(20060710) 	
Flexion (140 Normal)	140	140 with pain	
Extension (0 Normal)	0	0	
Comment	Crepitus present.	Crepitus and grinding present.	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the knee condition at 0%, code 5099-5003 (analogous to arthritis), citing a ROM of 0 to 14 degrees.  The VA rated the knee condition 10%, code 5261 (limitation of extension) citing a normal but painful ROM.  A rating of 10% under this code requires a loss of extension of 10 degrees.  The Board agreed the left knee condition did not rise to the level of 10% for painful motion IAW §4.40 and §4.59.  The Board concurred that the record in evidence did not support a rating under limitation of motion codes, 5260, 5261, or instability code 5257.  The Board agreed the knee condition was not compensable under code 5562 (knee impairment).  The Board found no other appropriate codes for consideration.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change in the PEB adjudication 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 left 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.

RECOMMENDATION:  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 20140411, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150009541 (PD201401683)

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:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA