RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2014-01716
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050725

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Infantryman) medically separated for knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “open fracture proximal right tibia w/medial tibia plateau fracture (right knee gunshot wound)” 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 right knee pain” as unfitting, rated 10% citing application of the US Army Physical Disability Agency (USAPDA) pain policy.   The CI made no appeals and was medically separated.   

CI CONTENTION: “The applicant contends his knee condition.  He also contends he was not evaluated for PTSD and a hearing condition.  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 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 20050610	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain, Status Post Gunshot Wounds...	5099-5003	10%	Right Knee, Residual of GSW with Retained Fragments	5099-5010	10%	20050524	
			Scars, Right Leg	7802	0%	20050524	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 5 (Not in Scope)	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20050922 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Right Knee Condition.  While deployed on 28 November 2004, the CI received a gunshot wound (GSW) in the right leg (across the knee) that resulted in a tibial plateau fracture.  He was evacuated from theater and underwent several surgeries for wound debridement and irrigation.  There were few encounter documents contained in the case file after the time of initial evacuation back to the States and therefore, most historical background was obtained from records generated by the MEB process.  His right tibial fracture was treated and the associated wound closed with secondary attention.  Progressive weight bearing of the right lower extremity ensued.  Despite physical rehabilitation, painful symptoms persisted.  He was permanently profiled on 29 March 2005 with a listed diagnosis of right knee GSW and referred to a MEB.  At the MEB narrative summary (18 April 2005; 3 months prior to separation) the CI reported persistent right knee pain with walking or running.  The physical examination (PE) revealed a mild antalgic gait.  There was trace effusion and slight tenderness about the right knee.  Range-of-motion (ROM) was measured from 0-120 degrees with pain.  There was no instability present.  The diagnosis was open fracture proximal right tibia with medial tibial plateau fracture.  

At the VA Compensation and Pension (C&P) examination (24 May 2005; 2 months prior to separation), the CI reported constant right knee pain.  The PE revealed an abnormal and asymmetric gait.  Decreased endurance of the right lower extremity was noted indicating weakness with a 4/5 graded measurement as well as decreased light touch and vibration.  There was decreased and painful motion of the right knee.  There was no comment regarding crepitus or guarding.  The VA’s diagnosis was status post open fracture of right tibial plateau with residuals of decreased ROM with pain and scarring.  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 Mo. Pre-Sep
(20050418) 	VA C&P ~2 Mo. Pre-Sep
(20050524) 	
Flexion (140 Normal)	120	90	
Extension (0 Normal)	0	0	
Comment	effusion; tenderness; antalgic gait	abnormal gait; painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA assigned a 10% rating under analogous codes of 5003 (degenerative arthritis) and 5010 (traumatic arthritis), respectively.  The PEB cited moderate and frequent pain whereas the VA citied painful motion for their rating.  The Board agreed that the PEB’s 10% rating was supported under the 5003 coding pathway by sufficient evidence of painful motion IAW VASRD §4.59 as seen at the VA examination.  Absent instability, frequent locking, dislocated cartilage, or worsening evidence of limited flexion, all Board members agreed that there were no available alternative joint or analogous coding options which are applicable and or advantageous to the CI’s current 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s 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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the knee was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right 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 20140418 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, AR20160003279 (PD201401716)

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