RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01861
BRANCH OF SERVICE:  Army	BOARD DATE:  20141212
SEPARATION DATE:  20080701

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Military Police) medically separated for a right knee condition.  The right knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The right knee condition, characterized as “right knee osteochondral defect” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “osteochondritis dissecans right” as unfitting, rated 10% with likely 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:

Service IPEB – Dated 20080609	VA - (10 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Osteochondritis Dissecans   …Right Knee	5099-5003	10%	Osteochondritis Dessicans, Right Knee 	5010	10%	20090504	
Other x 0  (Not in Scope)	Other x 1 (Not in Scope)	
Combined:  10%	Combined:  10%	

ANALYSIS SUMMARY:

Osteochondritis Dissecans Condition.  The narrative summary (NARSUM) noted the CI had sustained a cartilage injury (osteochondritis dessicans) of the right upper leg bone in the knee when he fell in the shower in November 2007 (right medial femoral condyle).  A subsequent magnetic resonance imaging (MRI) of the right knee revealed an unstable loose defect in the bone.  This was operatively stabilized with arthroscopic placement of several screws across the injured area on 14 March 2008.  Post-operatively, the fracture site healed but a painful knee condition developed.  At the MEB/NARSUM evaluation on 19 May 2008, 2 months after surgery and 2 months prior to separation, the CI reported being able to walk with “very little pain” for up to 2 miles but, being unable to run without pain.  The MEB physical exam noted a minimally antalgic gait.  The inner right knee was tender to palpation.  No instability of the knee was present.  Additional findings from this exam are summarized in the chart below.  MRI of the knee was reported as normal.  At the VA Compensation and Pension (C&P) exam performed 10 months after separation, the CI reported some pain and swelling of the knee.  He noted occasional feeling of the knee “locking” without episodes of falling, instability or dislocation.  At the time of the exam the CI was employed full-time as a cook and reported missing no work.  On physical examination, the gait was normal without an assistive device.  The knee was stable without laxity or dislocation.  Additional findings from this exam are summarized in the chart below.

The goniometric active range-of-motion (ROM) evaluations in evidence, which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below.

Right Knee ROM
(Degrees)	MEB ~ 2 Mo. Pre-Sep
(20080519) 	VA C&P ~ 10 Mo. Post-Sep
(20090504)	
Flexion (140 Normal)	112	145	
Extension (0 Normal)	lacks 11 degrees	0	
Comment	Minimal antalgic gait; Motion with pain; no instability 	No instability/dislocation. Motor/sensory normal.	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the knee condition 10% using different codes; the PEB rated using 5099-5003, analogous to arthritis and the VA, code 5010, (bursitis).  No higher rating than 10% is achievable under either code.  The Board agreed the knee condition rose to the level of 10%, but no more, for painful motion IAW §4.40.  The Board considered a rating under ROM codes.  The Board agreed the record in evidence did not support a rating under codes 5260, (limitation of flexion), but did support a rating under code 5261, (limitation of extension).  Under this code, a rating of 10% requires a loss of extension of 10 degrees.  A higher rating of 20% requires a loss of extension of 15 degrees.  The Board recommends of 10% rating under this code for reduced extension of 11 degrees.  The Board agreed that no rating could be recommended for instability of the knee under code 5257 (Instability).  The Board noted the report by the CI in the C&P evaluation of the “feeling of his knee occasionally locking” and considered a rating under code 5258 (cartilage/dislocated).  The Board agreed that this report was subjective as there were no clinical findings of knee instability, the record recorded no “frequent episodes of locking, falling, or effusion of the knee,” and X-rays revealed no unstable loose bony fragments within the knee joint.  The Board concluded it could recommend no rating under this code.  The Board agreed that no rating higher than 10% was supported under code 5262, (knee impairment) as the Board agreed the knee condition did not rise to the level of “moderate severity.”  The Board found no other appropriate codes for rating consideration.  The Board agreed that it could not duel rate the right knee condition for both pain and loss of extension.  Thus, the Board found no pathway to a disability rating higher than 10% for the knee condition.  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 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 DoDI 1332.39 for rating knee condition was operant in this case and the condition was adjudicated independently of that policy by the 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 20140415, 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, AR20150009952 (PD201401861)

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