RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02152
BRANCH OF SERVICE:  Army	BOARD DATE:  20150219
SEPARATION DATE:  20060105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Automated Logistical Specialist) medically separated for right knee condition.  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic right knee pain, status post autologous chondral site implantation and second look arthroscopy with debridement” was forwarded to the Physical Evaluation Board (PEB) as not meeting retention standards IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated chronic right knee pain as unfitting, rated 10%, with cited 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:

IPEB – Dated 20051108	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain Right Knee	5009-5003	10%	DJD, Right Knee…	5260-5010	10%	20060327	
Other x0	Other x5	
RATING:  10%	RATING:  30%	

*Derived from VA Rating Decision (VARD) dated 20060515 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:  

Chronic Pain, Right Knee:  While deployed in August 2003, the CI suffered a hyperextension injury to his right knee.  He sought care months later and a magnetic resonance imaging study revealed a large defect in the cartilage of the right knee.  The meniscus and ligaments were normal.  He was referred to orthopedics and underwent three surgical procedures between May and December 2004.  The service treatment records (STR) did not contain any evidence of instability episodes.  Extensive post-surgical physical therapy (PT) did not result in a decrease in his right knee pain and he was referred into the Disability Evaluation System.  At the MEB Medical Examination (DD Form 2807 & 2808) dated approximately 3 months prior to separation, the CI reported that his right knee gave out sometimes during everyday activities and that he had three prior surgeries on the right knee within a year.  The MEB findings are summarized in the chart below.  At the MEB narrative summary examination the CI reported that since surgery he continued to improve mildly.  He had been treated by PT and continued with intensive rehab to include pool therapy.  He continued on an activity limiting profile.  At the VA Compensation and Pension exam dated, approximately 3 months after separation, the CI reported weakness, fatigability, and lack of endurance, stiffness, and giving way.  He denied locking or swelling.  He had some localized numbness around the knee and 4/10 pain at rest while sitting in the exam room.  The right knee pain increased to 9-10/10 twice daily for about an hour.  The goniometric range-of-motion 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)	NARSUM ~4 Mo. Pre-Sep	Med Exam 2808 ~3 Mo. Pre-Sep	VA C&P ~3 Mo. Post-Sep	
Flexion (140 Normal)	125	No Limitation of Motion	110	
Extension (0 Normal)	0		0	
Comment	Pos. painful motion w/ minimal effusion; No instability; Pos. patellar crepitus 	Pos. painful motion; Decreased sensation lateral knee; Decreased leg strength; Normal reflexes	Pos. painful motion & crepitus ; No Deluca criteria; Pos. swelling; No instability; Antalgic gait	
§4.71a Rating	10%* (PEB 10%)	10%*	10%* (VA 10%)	

*IAW VASRD §4.59, Painful motion

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned the analogous VASRD code of 5099-5003 (degenerative arthritis) and rated it 0% citing the USAPDA pain policy for “slight.”  The VA applied VASRD code 5260 (limitation of leg flexion) with 5010 (arthritis due to trauma) and rated it 10% based on “painful or limited motion of a major joint.”  All three probative exams fail to document any instability, meniscal damage or limitation of motion that is compensable under any knee or leg specific VASRD code.  As per §4.20, analogous ratings, the Board recommends utilization of the analogous VASRD code 5299-5003 for rating purposes.  Rating under 5003 allows for a 10% rating when the non-compensable limitation of motion is objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.  The Board does find evidence of painful motion consistent with §4.59 in all three probative exams and the STRs present for Board review.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that the disability rating of 10% for the chronic right knee pain condition was appropriately applied in this case.

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 for rating chronic right knee pain was operant in this case and the condition was adjudicated independently of that policy by this Board.  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.

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 20140513, 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, AR20150010590 (PD201402152)

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