RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02159
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090211

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Infantryman, medically separated for “tendosynovitis resulting in right knee pain,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention in their application.  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 - 20081024	VARD - 20090519	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tendosynovitis Resulting in Right Knee Pain	5024	10%	Tendinitis and Osgood-Schlatter Disease, Right Knee	5024-5260	10%	20090304	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right Knee Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee condition began in October 2006 while participating in physical training and impact activities.  Diagnostic imaging revealed moderate to severe knee cap tendinosis as well as edema about the right tibial tuberosity suggestive of Osgood-Schlatter’s disease (inflammation of the knee cap ligament).  Degenerative changes about the right knee were also present.  Surgery was not indicated.  Despite conservative 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 an MEB.  The MEB forwarded “chronic right knee pain with tendonitis and bursitis” and “Osgood Schlatter” for PEB adjudication.  At the MEB NARSUM examination dated 19 August 2008, 6 months prior to separation, the CI reported right knee pain.  His physical examination (PE) revealed tenderness and increased prominence over the right tibial plateau.  There was no joint line tenderness about the right knee.  Examination maneuvers for ligamentous instability and meniscus pathology were negative.  Reflexes and sensation were normal and the examiner was silent regarding gait.  Range of motion (ROM) of the right knee was painful and minimally decreased by 5 degrees of flexion (normal = 140 degrees).  At the VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant right knee pain, with stiffness, associated fatigability and lack of endurance.  The pain was described as mild and was aggravated by prolonged walking, running, or lifting over 50 pounds.  The pain was relieved by non-prescription medication.  The PE revealed ROM of the right knee as painful and decreased by 10 degrees of flexion.  There was tenderness over the right tibial tuberosity.  His gait was normal and there was no knee instability.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5024 (tenosynovitis), citing evidence of painful motion.  The VA rated the right knee condition 10% coded 5024-5260 (tenosynovitis–leg; limitation of flexion), citing tenderness and painful motion.  Board members agreed that there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, evidence of painful motion with functional loss was present thus supporting a 10% rating (based on §4.59, §4.40 and §4.45).  The probative examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of a 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 their respective codes.  Additionally, 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 was no VASRD §4.71a route to a rating higher than the 10% adjudicated by the PEB under any other closely related code.  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 right knee condition.

BOARD FINDINGS:  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.  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, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160008537 (PD201402159)

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