RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01815
BRANCH OF SERVICE:  Army	BOARD DATE:  20150320
SEPARATION DATE:  20041119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 (Combat Infantryman) medically separated for right knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards but was authorized to perform an alternate physical fitness test.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic right knee pain…” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “right knee pain” as unfitting, rated 10% with cited application of the US Army Physical Disability Agency (USAPDA) pain policy.  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 20041019	VA* - (~17 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5099-5003	10%	Right Knee Degenerative Joint Disease	5257-5010	10%	20060629	
Other x 0	Other x 7	
RATING:  10%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20060821 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separation.

Right Knee Pain Condition.  The CI suffered a right knee injury when he fell into a hole during a night training exercise in October 2003.  He had continued pain and a magnetic resonance imaging study revealed a “thinned” anterior cruciate ligament (ACL) without effusion.  When treatment with physical therapy (PT) and non-steroidal anti-inflammatory medications (NSAIDS) did not decrease his pain, he was referred to orthopedic surgery for evaluation.  In February 2004, the CI underwent an arthroscopic reconstruction of his right ACL.  He had post-surgical numbness of the right lower leg but no weakness.  The narrative summary (NARSUM) prepared almost 3 months prior to separation noted that post-operatively his medial joint pain never improved.  He had no complaints of instability.  He had a full course of conservative measures post-operatively for 5 months without significant improvement in his symptoms.  The pertinent physical exam findings are summarized in the chart below.  At the VA Compensation and Pension (C&P) exam performed 17 months after separation, documented “COURSE SINCE ONSET: Improved.  CURRENT TREATMENTS FOR THIS CONDITION: Medication (NSAIDS) Physical Therapy, Activity Limitation.  A plain film x-ray revealed “No abnormalities of the right knee.”  Pertinent physical exam findings are in the following chart.

The goniometric range-of-motion 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)	NARSUM ~4 Mo. Pre-Sep	VA C&P ~17 Mo. Post-Sep	
Flexion (140 Normal)	125	120	
Extension (0 Normal)	0	-10	
Comment	No instability or effusion; decreased sensation; good muscle tone; Normal strength	Antalgic gait; Pos. painful motion; No crepitus or instability; No Deluca criteria	
§4.71a Rating	0% or 10% (PEB 10%)	10%* (VA 10%)	
*IAW VASRD §4.59, painful motion

The Board directed attention to its rating recommendation based on the above evidence.  The PEB applied the analogous VASRD code on 5099-5003 (degenerative arthritis) and rated it 10% citing the USAPDA pain policy.  The VA applied the combination code of 5257 (other impairments of the knee) with 5010 (arthritis due to trauma) and also rated it 10% citing, “…based on the VA examination which showed you have painful movement of the right knee.”  The Board notes that the C&P exam is outside the DoDI 6040.44 defined 12-month period for consideration of after separation VA findings, thus awarding exclusive probative value to the NARSUM exam.  The service treatment record evidence does not document any compensable ROM measurements, instability, or any other findings to support any appropriate coding/rating recommendations greater than the 10% rating granted by the PEB.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the right knee pain condition was appropriately recommended in this case.

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 right knee pain was operant in this case and the condition was adjudicated independently of that policy by this Board.  In the matter of the right knee pain 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

XXXXXXXXXXXXXXX
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, AR20150013660 (PD201401815)

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