RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01896
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated for “chronic right knee pain” with a disability rating of 10%.

CI CONTENTION:  “Other service connected issues to be added.”  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 - 20081120	VARD – 20090306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	10%	S/P Right Knee Surgery with Patellofemoral Syndrome	5260	10	20090129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Right Knee Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent three right knee surgeries prior to enlistment.  On his enlistment physical examination, 10 October 2007, he was cleared by the orthopedist and qualified for duty.  In July of 2008, he was involved in a road march which exacerbated his right knee condition.  Diagnostic imaging in July 2008 showed two screws in the proximal tibia with no other acute abnormality.  Orthopedic clinic examinations of the right knee in July, August and September 2008 demonstrated patella crepitus, patellofemoral region tenderness, normal range of motion (ROM) and no instability. The CI was assigned a permanent L3 profile and was permitted to take the alternate aerobic physical fitness test. Despite treatment, the right knee condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “chondromalacia patella, right knee” for PEB adjudication.  At the orthopedic clinic examination (addendum to the MEB narrative summary (NARSUM)) dated 22 October 2008, 3 months prior to separation, the CI reported pain at 8/10 intensity, sharp in nature.  Physical examination showed right knee joint stiffness but no swelling.  There was pain around the knee cap.  The right knee did not lock up either intermittently or suddenly.  The right knee was tender to palpation in all regions with exception of the lateral joint line.  Painful motion was noted and a patellofemoral grinding test was positive. All tests for instability were negative.  The knee demonstrated no muscle weakness.  A diagnostic imaging examination (magnetic resonance imaging) on 29 October 2008, 3 months prior to separation, showed ligamentous structures intact, normal soft tissues, no evidence of menisci tear and a relatively unremarkable right knee.  The MEB NARSUM, dated 30 October 2008, 3 months prior to separation, referenced focused examinations by orthopedics and stated there were no anticipated surgical approaches anticipated.  The orthopedic clinic examination on 6 November 2008, 3 months prior to separation, was similar to the orthopedic examinations referenced above, with normal ROM noted and no instability.

At the VA Compensation and Pension (C&P) examination on 29 January 2009, performed 10 days after separation, the CI reported chronic soreness in his right knee, exacerbated by prolonged weight bearing, any heavy lifting and repetitive squatting.  The CI could not run due to pain.  He had no weakness or stiffness, no giving way, no locking and he used no prosthetic or assistive devices to ambulate. He experienced fatigability and lack of endurance as a result of exacerbating activities as described.  Physical examinatino showed a well-healed anterior tibial surgical scar of no clinical significance. There was no effusion and ligaments were intact.  Tests for instability were negative. There was tenderness along the medial joint line.  Active ROM measurements were recorded per chart above.  Marked crepitus was noted with flexion/extension.   The examiner estimated that running activities or prolonged standing would decrease ROM to 90 degrees, secondary to pain.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (degenerative arthritis), citing loss of knee joint motion, permanently service aggravated with no EPTS (existed prior to service) deduction.  The VA also assigned a 10% rating using the 5260 code (leg, limitation of flexion of) based on the VA C&P examination 10 days after separation, citing objective evidence of painful motion.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  The examinations proximate 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), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic right knee pain condition.  

BOARD FINDINGS:  In the matter of the chronic 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.  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 20140413, 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
(AH RC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160008527 (PD201401896)

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