RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-01992
BRANCH OF SERVICE:  ARMY	BOARD DATE:  20140827
SEPARATION DATE:  20020515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (13B/Cannon Crew Member) medically separated for a right knee condition.  The 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 arthritis” and “status post medial meniscus tear (MMT)” by the MEB was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right knee arthritis status post anterior cruciate ligament reconstruction and medial meniscectomy” as unfitting and rated it at 10%.  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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting right knee condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20020416	VA - (3 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Arthritis…	5003	10%	Degenerative Joint Disease, Right Knee, s/p ACL and MMT Repair	5010-5259	10%	20020205	
Other x 0 (Not in Scope)	Other x 3	20020205	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20020516 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Right Knee Condition.  The CI originally injured his right knee after jumping from a military vehicle in April 2000.  Radiology tests confirmed a torn right anterior cruciate ligament and meniscal tear, both arthroscopically addressed in August 2000.  Despite aggressive post-operative physical therapy, he continued with right anterior knee pain and was referred for an MEB.

At the VA Compensation and Pension examination (performed 3 months prior to separation), the CI reported persistent right knee pain (3-6/10) with full extension.  He endorsed occasional knee swelling, difficulty with walking more than 1/4 mile, and the inability to run.  He denied locking or instability of the knee.  The physical examination (PE) revealed “marked guarding of the right knee” and “marked quad atrophy.”  There was crepitus noted behind the right knee.  There was limited extension range-of-motion (ROM) and his gait was antalgic.  His diagnosis was degenerative joint disease status post prior surgical intervention.

At the narrative summary examination (2 months prior to separation) the CI reported constant right knee pain aggravated by stooping, bending, and walking.  He endorsed swelling, and “give-way” while walking and pivoting.  The PE revealed global joint-line tenderness and painful motion.  Stability tests were normal indicating a “strong end-point.”  There was no effusion present.  There was no comment in regards to the presence of muscular atrophy.  Motor strength testing was 4/5.  His diagnosis remained right knee arthritis status post arthroscopic surgery.  The commander’s letter of evaluation indicated an unsatisfactory performance of duty due to his “physical impairments.”  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)	VA C&P ~3 Mo. Pre-Sep
(20020205) 	NARSUM ~2 Mo. Pre-Sep
(20020313) 	
Flexion (140 Normal)	- (not reported)	“Full”	
Extension (0 Normal)	10	5	
Comment	-	painful motion	
§4.71a Rating	NR (non-ratable)	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis).  Using an analogous dual code 5010-5259 (traumatic arthritis-cartilage removal), the VA also assigned a 10% rating citing surgical intervention with cartilage removed.

The ROM values reported by the VA examiner, 3 months prior to separation, were inadequately documented as compared to those reported by the MEB dated 2 months closer to the date of separation.  For purposes of the Board’s rating recommendation, Board members concluded that the MEB examination carried the highest probative value.  It was the more proximate to the date of separation and its objective examination was most detailed, accurate, and complete.  The Board agreed that the PEB’s 10% rating was supported under the 5003 coding pathway by sufficient evidence of painful motion (§4.59); or alternatively, under the 5259 code due to surgical intervention and the removal of cartilage.  It was also considered and agreed that frequent locking of the right knee due to dislocated cartilage was not present and therefore a 20% rating was not justified under the 5258 code.  Lastly, Board members considered analogous coding of 5299-5262 (tibia and fibula impairment), but the pathology and symptoms of pain would maximally support only slight (10%) knee disability.  Absent instability, or worsening evidence of limited flexion, the Board agrees that there are 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.  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 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140502, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXX, AR20150006358 (PD201401992)

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