RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX                      	CASE:  PD-2014-02438
BRANCH OF SERVICE:  army	SEPARATION DATE:  20060523

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Active Duty E4, Computer Detection Systems Repairer, medically separated for “chronic right knee pain, retropatellar,” with a disability rating of 0%.

CI CONTENTION:  “Please consider all conditions.”  The applicant’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 – 20060327	VARD - 20060718	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Knee Pain	5099-5003	0%	RPPS/Chondromalacia, Right Knee	5257	10%	20060706	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Right Knee Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered persistent right knee pain after a fall in July 2002 during basic training.  Magnetic resonance imaging was normal, and the diagnosis was retropatellar pain syndrome (RPPS) with chondromalacia patella (damage to the cartilage under the knee cap).  There were several entries in the STR documenting grossly normal range-of-motion (ROM), although there was evidence for painful motion.  There was ample documentation of ligamental stability in all planes, the absence of locking or impingement, and the absence of effusion.  There was occasional mention of antalgic gait, but no documentation of braces or assistive devices.  There was no evidence contrary to any of these ratable features.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “right knee pain, [RPPS], chondromalacia patella pain is localized to the right knee, specifically the medial femoral condyle and patellofemoral region” to the PEB.
 
At the NARSUM examination on 12 December 2005, performed 5 months before separation, the CI reported right knee pain aggravated with running, prolonged standing, squatting, jumping and stair stepping.  The physical examination recorded tenderness, crepitus, the absence of effusion, and the absence of impingement (no documentation of stress testing for stability).  An addendum to the NARSUM (9 February 2006, 3½ months pre-separation) provided formal ROM measurements: flexion to 130 degrees (normal 140, 45 for minimum 10%) and extension 0 degrees (normal), specifying painful motion.

At the VA Compensation and Pension (C&P) examination on 6 July 2006, performed 1 month after separation, the CI reported he could climb one flight of stairs, walk 20 to 30 feet, but could not run.  The physical examination recorded an antalgic gait without mention of brace or assistive device, tenderness, and the absence of effusion.  Although noting “no difficulty with drawer sign or with twisting or turning,” the examiner did not document medial or lateral stress testing, but stated “has some slight instability.”  The VA ROM evidence was flexion to 130 degrees, specifying painful motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 0%, coded analogously to 5003 (arthritis, degenerative), citing “involvement of one joint.”  Members agreed, however, that painful motion was well supported by the evidence (and acknowledged in the PEB’s DA Form 199 decision) in justification of the minimum 10% rating.  The VA rated the right knee condition 10% under the 5237 code which rates for instability, citing the “slight instability” referenced in the C&P examination; but, members agreed that there was insufficient objective evidence for instability to justify additional rating under 5237.  There was no ROM limitation, persistent effusion and locking, or fracture with non-union or malunion to achieve a rating higher than 10% under any alternate code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the right knee condition, proposing code 5024 (tenosynovitis) for its clinical compatibility.

In the matter of the right knee condition, the Board unanimously recommends a disability rating of 10%, coded 5024 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Retropatellar Pain Syndrome, Right Knee	5024	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140501, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160007503 (PD201402483)

1. I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoDPDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
accept the Board's recommendation to modify the individual's disability rating to 10%
without re-characterization 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:

CF:
( ) DoD PDBR
( ) DVA