RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02001
BRANCH OF SERVICE:  Army	BOARD DATE:  20141017
SEPARATION DATE:  20041120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (63B/Light Wheel Vehicle Mechanic) medically separated for chronic right knee pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The chronic right knee pain condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated chronic right knee pain as unfitting, rated 0%.  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 chronic right knee pain condition is addressed below; 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 20040831	VA -  Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099 5003	0%	Patella Chondromalacia, Right Knee	5299-5257	10%	STR	
Other x 0  (Not in Scope)	Other x 1 	20050405	
Combined:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20051227 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Right Knee Condition:  Absent a history of direct trauma, the CI developed right-sided knee pain in late 2002.  His painful symptoms increased with activity and prolonged standing.  Radiology test revealed an osteochondritis dessicans lesion (tear or fracture of the cartilage covering a bone within a joint) under the right kneecap.  On 15 April 2004, he underwent a non-complicated diagnostic surgical exploration of the lesion.  Post-operatively, the CI was “non-compliant” with physical therapy and hence was released from that specialty and informed to follow-up with orthopedics.  Despite having full range-of-motion (ROM) in mid May 2004, persistent knee pain led to an MEB.  At the narrative summary (NARSUM) examination dated 28 July 2004 (4 months prior to separation) the CI endorsed severe right knee pain.  
His physical examination (PE) revealed a stable, neurovascular normal right knee with full ROM.  The patellar grind test was positive (test that assesses the presence of abnormal kneecap movement and accompanying degree of painful crepitation...ie; painful motion). The DD Form 2808 dated 8 July 2004 also noted “pain with flexion of right knee.”  His diagnosis remained as right knee pain and the examiner noted his prognosis as “good.”  His permanent profile endorsed the single right knee condition and the commander’s statement acknowledged the inability to perform his designated MOS duties under the prescribed restrictions.  The VA Compensation & Pension examination performed on 5 April 2006 (15 months post separation). The CI endorsed daily bilateral knee pain (right > left) associated with stiffness and weakness.  He denied periods of incapacitation and or problems with standing.  The PE revealed a normal gait with normal ROM and stability to both knees.  There was painful motion and crepitus in the right knee.  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 ~ 4 Mo. Pre-Sep
(20040728) 	VA C&P ~ 15 Mo. Post-Sep
(20060405) 	
Flexion (140 Normal)	140	140	
Extension (0 Normal)	0	0	
Comment	painful motion	painful motion; 
(+) crepitus 	
§4.71a Rating	10%	10%	

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and VA utilized analogous coding options citing different primary identifiers.  Both used code 5003 (degenerative arthritis) at 0% and 5257 (knee, impairment) at 10% respectively.  It is noted for the record that the Board recognizes the significant interval (15 months) between the date of separation and the VA evaluation.  DoDI 6040.44, under which the Board operates, specifies a 12-month interval for special consideration to VA findings.  This does not mean that the VA information was disregarded, but rather less probative value can be assigned to the VA examination.  Members agreed that the greatest probative value is assigned to the NARSUM evaluation.  Although non-compensable ROM was present near the time of separation, the MEB examination clearly indicated painful motion (§4.59) supporting a 10% rating.  Absent effusion, meniscal removal, or instability, there is no route to an impairment rating higher than 10% (§4.59) under any other applicable knee codes.

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, the Board unanimously recommends a disability rating of 10% coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Right Knee Pain Condition	5099-5003	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140505, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20150008220 (PD201402001)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl			     XXXXXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA