RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02089
BRANCH OF SERVICE:  Army	BOARD DATE:  20150310
SEPARATION DATE:  20040126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 (Military Police) 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 “degenerative joint disease (DJD) right knee” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated the condition as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  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 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 20031203	VA* (8 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DJD, Right Knee	5003	10%	DJD, Right Knee	5261	10%	20040916	
Other x 0 (Not In Scope)	Other x 8	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20050729 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Right Knee Condition.  The service treatment record (STR) indicated an initial sports injury to the right knee in September 2001 (on a drill weekend), and imaging at that time demonstrated a meniscal tear.  The CI was referred to orthopedics (military), and in November 2002 (13 months prior to separation), underwent surgery (arthroscopic meniscectomy).  A physical therapy entry from March 2003 documented a full range-of-motion (ROM) and uncomplicated operative recovery.  After that, the CI was deployed to Kuwait/Iraq; and, a line-of-duty statement documented a right knee injury from a reported fall off a guard tower ladder in Kuwait on 13 June 2003, with medical evacuation (to CONUS) 5 days later.  Subsequent STR entries indicated a trial of conservative treatment with improvement, but insufficient for retention.  Several entries documented measured ROM, with flexion ranging from 110-125 degrees (normal 140 degrees; minimum compensable 45 degrees); and, multiple exams documented the absence of instability, persistent effusion, or signs of cartilage impingement (mechanical locking).

The narrative summary (NARSUM) conducted on 3 October 2003 (4 months prior to separation), attributed the knee pain to the physical rigors of deployment without mention of discrete injury.  The examiner stated that the “knee pops and hurts sometimes, mostly at night, sitting with the knee bent and on getting up and walking up and down steps” with pain rated “intermittent and slight.”  The physical exam documented that the CI “walks, sits, and stands well,” noting the absence of tenderness and a stable joint.  The NARSUM measured ROM was 105 degrees flexion and minus 8 degrees extension (normal 0 degrees, minimum compensable minus 10 degrees).

A VA Compensation and Pension (C&P) examination conducted on 16 September 2004 (8 months after separation) did not characterize the severity of the knee pain; the examiner stated, “His knee is alright until he walks long time or stands up a long time.”  The VA physical exam documented a “minimal limp,” the absence of effusion (no comment on tenderness), stability to stress testing, and no signs of cartilage impingement.  The VA measured ROM was 115 degrees flexion annotating painful motion.  Measured extension was not provided, but the examiner commented, “sitting in chair he lacks about 15 degrees of full extension.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating analogous to 5003 (degenerative arthritis) was consistent with VASRD §4.71a criteria for the MEB and NARSUM evidence and ROM.  The VA’s 10% rating under 5261 (limitation of extension) referenced the C&P comment above.  It is noted that a 10% rating under 5259 (cartilage, semilunar, removal of, symptomatic) is likewise appropriate to this case.  There is no evidence for compensable ROM impairment, frequent effusions, or locking which would support a rating higher than 10% under any applicable code; and, no grounds for additional rating 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 of 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 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, AR20150013720 (PD201402089)

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